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General NPI Number Information
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NPI Number | 1316679467
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Entity Type | Organization
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Legal Business Name | WILLOW ANXIETY AND OCD
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Dates
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Enumeration Date | 06/28/2022
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 431 MONTEREY AVE
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City | LOS GATOS
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State | CA
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Zip | 95030-5319
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Country | US
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Telephone | 215-667-8883
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Fax |
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Provider Business Mailing Address
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Address Line | 28 CORTEZ RD
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City | REDWOOD CITY
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State | CA
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Zip | 94062-3246
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Country | US
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Telephone | 650-274-9595
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TEJAL JAKATDAR
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Credential | PHD
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Telephone | 215-667-8883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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