Provider Demographics
NPI:1023256070
Name:ADOLESCENT COUNSELING SERVICES
Entity type:Organization
Organization Name:ADOLESCENT COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIPPE
Authorized Official - Middle Name:
Authorized Official - Last Name:REY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:650-424-0852
Mailing Address - Street 1:4000 MIDDLEFIELD RD
Mailing Address - Street 2:SUITE FH
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-4760
Mailing Address - Country:US
Mailing Address - Phone:650-424-0852
Mailing Address - Fax:650-424-9853
Practice Address - Street 1:4000 MIDDLEFIELD RD
Practice Address - Street 2:SUITE FH
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-4760
Practice Address - Country:US
Practice Address - Phone:650-424-0852
Practice Address - Fax:650-424-9853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA910-1790-5251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health