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General NPI Number Information
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NPI Number | 1609679281
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Entity Type | Organization
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Legal Business Name | GENTLE HEALING TRAUMA PSYCHOTHERAPY
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 06/29/2025
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Provider Practice Location Address
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Address Line | 39812 MISSION BLVD STE 106
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City | FREMONT
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State | CA
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Zip | 94539-3087
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Country | US
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Telephone | 510-366-8581
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Fax |
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Provider Business Mailing Address
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Address Line | 39812 MISSION BLVD STE 106
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City | FREMONT
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State | CA
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Zip | 94539-3087
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Country | US
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Telephone | 510-366-8581
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Fax |
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Authorized Official
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Title or Position | OWNER, LMFT
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Name | NANCI HYUN RYUNG KIM
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Credential | LMFT
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Telephone | 510-500-5964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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