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General NPI Number Information
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NPI Number | 1265803696
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Entity Type | Individual
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Provider Name | JACK HILLS
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Gender | Male
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 167 S SAN ANTONIO RD STE 2
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City | LOS ALTOS
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State | CA
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Zip | 94022-3055
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Country | US
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Telephone | 650-422-7475
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Fax |
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Provider Business Mailing Address
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Address Line | 100 1/2 E HALEY ST APT B
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City | SANTA BARBARA
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State | CA
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Zip | 93101-2353
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 36182
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License Number State | CA
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