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General NPI Number Information
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NPI Number | 1497121297
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Entity Type | Organization
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Legal Business Name | SEQUOYAH COUNSELING CENTER
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Dates
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Enumeration Date | 08/15/2015
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Last Update Date | 08/15/2015
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Provider Practice Location Address
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Address Line | 21168 REDWOOD RD STE 100A
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5932
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Country | US
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Telephone | 510-909-6476
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Fax |
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Provider Business Mailing Address
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Address Line | 21168 REDWOOD RD STE 100A
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5932
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Country | US
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Telephone | 510-909-6476
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JEFFREY EDWIN KLIPPENES
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Credential | MA
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Telephone | 510-646-0123
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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 | MS17907
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License Number State | CA
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