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General NPI Number Information
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NPI Number | 1760736458
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL DIRECTION
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Dates
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Enumeration Date | 11/01/2012
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 131 ESMEYER DR
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City | SAN RAFAEL
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State | CA
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Zip | 94903-3770
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Country | US
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Telephone | 415-971-1186
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Fax | 415-366-1685
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Provider Business Mailing Address
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Address Line | 131 ESMEYER DR
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City | SAN RAFAEL
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State | CA
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Zip | 94903-3770
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Country | US
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Telephone | 415-971-1186
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Fax | 415-366-1685
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALEX CAMPBELL
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Credential |
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Telephone | 415-971-1186
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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 | MFC30244
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-08-4718
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License Number State |
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