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General NPI Number Information
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NPI Number | 1710652128
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Entity Type | Organization
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Legal Business Name | ARBORVITAE INDIVIDUAL, MARRIAGE, AND FAMILY THERAPY, INC.
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Dates
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Enumeration Date | 08/09/2021
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Last Update Date | 08/09/2021
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Provider Practice Location Address
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Address Line | 2300 TIOGA DR
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City | MENLO PARK
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State | CA
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Zip | 94025-6642
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Country | US
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Telephone | 408-230-9023
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 581
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City | SAN CARLOS
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State | CA
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Zip | 94070-0581
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Country | US
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Telephone | 408-230-9023
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATTHEW DANIEL AHRENS
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Credential | CALIFORNIA LMFT
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Telephone | 408-230-9023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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