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General NPI Number Information
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NPI Number | 1154729762
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Entity Type | Organization
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Legal Business Name | PSYCHED IN SAN FRANCISCO
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Dates
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Enumeration Date | 12/12/2014
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Last Update Date | 12/12/2014
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Provider Practice Location Address
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Address Line | 582 MARKET ST STE 1110
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City | SAN FRANCISCO
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State | CA
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Zip | 94104-5312
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Country | US
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Telephone | 415-520-5567
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Fax |
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Provider Business Mailing Address
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Address Line | 582 MARKET ST STE 1110
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City | SAN FRANCISCO
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State | CA
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Zip | 94104-5312
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Country | US
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Telephone | 415-520-5567
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | TRACI RUBLE
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Credential | MA MFC51082
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Telephone | 415-520-5567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MFC51082
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License Number State | CA
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