=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598994642
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PORTIA BELL HUME BEHAVIORAL HEALTH AND TRAINING CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2009
-----------------------------------------------------
Last Update Date | 10/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39420 LIBERTY ST STE 252
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94538-2297
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-745-9151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39420 LIBERTY ST STE 140
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94538-2289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-745-9151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOTY SIKAND
-----------------------------------------------------
Credential | PSY. D.
-----------------------------------------------------
Telephone | 510-745-9151
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------