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General NPI Number Information
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NPI Number | 1750714796
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Entity Type | Individual
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Provider Name | IAN VIANU LMFT
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Gender | Male
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 2577 SAN PABLO AVE
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City | OAKLAND
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State | CA
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Zip | 94612-1159
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Country | US
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Telephone | 510-292-5698
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Fax |
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Provider Business Mailing Address
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Address Line | 3021 TELEGRAPH AVE STE C
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City | BERKELEY
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State | CA
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Zip | 94705-2072
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Country | US
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Telephone | 510-502-9655
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 83012
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 83012
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 99388
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License Number State | CA
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