Healthcare Provider Details

I. General information

NPI: 1609549294
Provider Name (Legal Business Name): HUMAN HEALTH OF CALIFORNIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 INNOVATION CAMPUS WAY
NEW ALBANY OH
43054
US

IV. Provider business mailing address

2269 CHESTNUT ST # 523
SAN FRANCISCO CA
94123-2600
US

V. Phone/Fax

Practice location:
  • Phone: 415-851-0195
  • Fax:
Mailing address:
  • Phone: 415-851-0195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CARRIE KOCEN
Title or Position: CREDENTIALING
Credential:
Phone: 415-851-0195