=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881751469
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. MAXINE FISCHER BECKER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2007
-----------------------------------------------------
Last Update Date | 12/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 565 CASTRO ST
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94041-2009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-909-2850
-----------------------------------------------------
Fax | 650-903-2877
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 565 CASTRO ST
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94041-2009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-909-2850
-----------------------------------------------------
Fax | 650-903-2877
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LCS #15401
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------