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General NPI Number Information
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NPI Number | 1992107007
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Entity Type | Organization
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Legal Business Name | CENTER FOR THERAPEUTIC ALLIANCE
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 625 14TH ST SUITE B
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City | PASO ROBLES
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State | CA
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Zip | 93446-2285
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Country | US
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Telephone | 805-876-5413
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Fax | 805-876-5412
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Provider Business Mailing Address
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Address Line | 625 14TH ST SUITE B
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City | PASO ROBLES
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State | CA
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Zip | 93446-2285
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Country | US
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Telephone | 805-876-5413
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Fax | 805-876-5412
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Authorized Official
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Title or Position | PARTNER
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Name | PATRICIA M GLICKMAN
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Credential | MFT
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Telephone | 805-610-8729
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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 | MFC49152
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY26358
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License Number State | CA
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