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General NPI Number Information
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NPI Number | 1326591777
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Entity Type | Individual
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Provider Name | NICOLE J KALLAS
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Gender | Female
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Dates
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Enumeration Date | 08/02/2016
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 2222 BANCROFT WAY FL 3
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City | BERKELEY
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State | CA
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Zip | 94720-4301
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Country | US
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Telephone | 510-642-9494
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Fax |
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Provider Business Mailing Address
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Address Line | 1246 WALKER AVE APT 204
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City | WALNUT CREEK
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State | CA
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Zip | 94596-4835
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 129667
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License Number State | CA
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