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General NPI Number Information
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NPI Number | 1013159631
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Entity Type | Organization
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Legal Business Name | WILLOW FAMILY THERAPY INC
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 03/27/2009
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Provider Practice Location Address
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Address Line | 80 EUREKA SQ SUITE 216
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City | PACIFICA
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State | CA
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Zip | 94044-2654
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Country | US
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Telephone | 650-355-0841
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Fax |
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Provider Business Mailing Address
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Address Line | 80 EUREKA SQ SUITE 216
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City | PACIFICA
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State | CA
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Zip | 94044-2654
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Country | US
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Telephone | 650-355-0841
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | STEPHANIE P ELLIOTT
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Credential | MFT
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Telephone | 650-355-0841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC40528
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License Number State | CA
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