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General NPI Number Information
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NPI Number | 1538549415
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Entity Type | Organization
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Legal Business Name | STACEY KOLSRUD
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 870 MARKET ST SUITE 1186
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City | SAN FRANCISCO
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State | CA
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Zip | 94102-3099
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Country | US
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Telephone | 415-255-2591
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Fax |
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Provider Business Mailing Address
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Address Line | 1939 HAYES ST APT 6
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City | SAN FRANCISCO
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State | CA
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Zip | 94117-1157
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Country | US
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Telephone | 415-265-1985
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Fax |
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Authorized Official
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Title or Position | MFT
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Name | STACEY KOLSRUD
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Credential | MA, MFT
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Telephone | 415-265-1985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 86928
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License Number State | CA
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