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General NPI Number Information
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NPI Number | 1669311007
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Entity Type | Organization
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Legal Business Name | BIG LIFE CHANGE THERAPY
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Dates
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Enumeration Date | 03/27/2026
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Last Update Date | 03/27/2026
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Provider Practice Location Address
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Address Line | 822 D ST
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City | SAN RAFAEL
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State | CA
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Zip | 94901-2814
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Country | US
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Telephone | 510-831-3502
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Fax |
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Provider Business Mailing Address
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Address Line | 822 D ST
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City | SAN RAFAEL
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State | CA
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Zip | 94901-2814
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AMFT
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Name | GABRIELLE LOPEZ
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Credential |
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Telephone | 646-228-8602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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