=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194481176
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BEA ARMSTRONG MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2021
-----------------------------------------------------
Last Update Date | 11/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8107 ABBY LANE CIR
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77379-4501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-486-9202
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3141 STEVENS CREEK BLVD # 341
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95117-1141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-486-9202
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC30226
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------