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General NPI Number Information
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NPI Number | 1457907040
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Entity Type | Organization
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Legal Business Name | THREE BRIDGES PSYCHOLOGY & MEDIATION
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Dates
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Enumeration Date | 08/11/2019
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Last Update Date | 08/11/2019
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Provider Practice Location Address
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Address Line | 402 COLUSA AVE
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City | EL CERRITO
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State | CA
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Zip | 94530-3327
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Country | US
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Telephone | 510-913-2232
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Fax |
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Provider Business Mailing Address
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Address Line | 3060 EL CERRITO PLZ # 405
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City | EL CERRITO
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State | CA
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Zip | 94530-4011
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Country | US
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Telephone | 510-913-2232
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JANELLA STREET
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Credential | PSYD
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Telephone | 510-847-7452
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number |
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License Number State |
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