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General NPI Number Information
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NPI Number | 1376636118
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Entity Type | Organization
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Legal Business Name | FAMILIY SERVICE OF SAN LEANDRO
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 2208 SAN LEANDRO BLVD
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City | SAN LEANDRO
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State | CA
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Zip | 94577-5957
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Country | US
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Telephone | 510-483-6715
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Fax | 510-483-6719
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Provider Business Mailing Address
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Address Line | 2208 SAN LEANDRO BLVD
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City | SAN LEANDRO
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State | CA
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Zip | 94577-5957
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Country | US
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Telephone | 510-483-6715
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Fax | 510-483-6719
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DIANA MORALES
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Credential |
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Telephone | 510-483-6715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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