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General NPI Number Information
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NPI Number | 1366801482
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Entity Type | Organization
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Legal Business Name | WALNUT CREEK DBT PSYCHOLOGY CLINIC
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 45 QUAIL CT SUITE 204
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City | WALNUT CREEK
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State | CA
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Zip | 94596-5547
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Country | US
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Telephone | 925-956-4636
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Fax |
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Provider Business Mailing Address
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Address Line | 45 QUAIL CT SUITE 204
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City | WALNUT CREEK
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State | CA
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Zip | 94596-5547
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Country | US
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Telephone | 925-956-4636
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PATRICIA ZURITA ONA
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Credential |
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Telephone | 925-956-4636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 24279
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License Number State | CA
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