=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851911366
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHIL CONCEPTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2020
-----------------------------------------------------
Last Update Date | 04/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1656 CALIFORNIA ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94109-4604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-489-4465
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1656 CALIFORNIA ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94109-4604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER AND CEO
-----------------------------------------------------
Name | JOE BURTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-239-2635
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------