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General NPI Number Information
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NPI Number | 1750921623
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Entity Type | Organization
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Legal Business Name | MIND & SPIRIT COUNSELING CENTER
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Dates
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Enumeration Date | 01/08/2020
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Last Update Date | 01/08/2020
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Provider Practice Location Address
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Address Line | 90 MISSION DR STE 5
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City | PLEASANTON
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State | CA
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Zip | 94566-7655
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Country | US
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Telephone | 925-960-3552
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Fax |
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Provider Business Mailing Address
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Address Line | 1138 FLORENCE RD
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City | LIVERMORE
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State | CA
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Zip | 94550-5545
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Country | US
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Telephone | 925-960-3552
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JILL MATTESICH-UDOUTCH
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Credential |
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Telephone | 925-960-3552
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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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