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General NPI Number Information
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NPI Number | 1386336501
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Entity Type | Organization
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Legal Business Name | BANYAN PSYCHOLOGY INC.
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Dates
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Enumeration Date | 05/25/2023
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 877 MAHLER RD STE 160
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City | BURLINGAME
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State | CA
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Zip | 94010-1640
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Country | US
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Telephone | 650-822-1057
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Fax | 650-563-5570
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Provider Business Mailing Address
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Address Line | 877 MAHLER RD STE 160
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City | BURLINGAME
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State | CA
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Zip | 94010-1640
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Country | US
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Telephone | 650-822-1057
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Fax | 650-563-5570
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM CHAN
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Credential | PSY.D.
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Telephone | 650-667-7193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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