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NPI Code Detail

MEDICARE: AZALEAH GOOSE APCC

MEDICARE: AZALEAH GOOSE APCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorAPCC11952CA

General Provider Information

NPI Number : 1508532466
Entity Type Code : Individual
Provider Name (Legal Business Name) : AZALEAH GOOSE APCC
Provider Business Mailing Address
First Line : 490 LAKE PARK AVE UNIT 10694
Second Line :
City : OAKLAND
State : CA
Zip : 94610-8025
Country : US
Telephone Number : 510-269-7726
Fax Number :
Provider Business Practice Location Address
First Line : 2903 SACRAMENTO ST
Second Line :
City : BERKELEY
State : CA
Zip : 94702-2509
Country : US
Telephone Number : 510-269-7726
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2021
Last Update Date : 04/21/2026

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