=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932693835
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUPPORT-COUNSELING INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2018
-----------------------------------------------------
Last Update Date | 06/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 FREMONT AVE STE 260H
-----------------------------------------------------
City | LOS ALTOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94024-6058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-430-3401
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22639 OAKCREST CT
-----------------------------------------------------
City | CUPERTINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95014-0830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-568-6443
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. IRIS COHEN
-----------------------------------------------------
Credential | MFT
-----------------------------------------------------
Telephone | 408-568-6443
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 93750
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------