Provider Demographics
NPI:1023642006
Name:WESTCOAST THERAPY AND WELLNESS PROFESSIONAL CLINICAL COUNSELOR PC
Entity type:Organization
Organization Name:WESTCOAST THERAPY AND WELLNESS PROFESSIONAL CLINICAL COUNSELOR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:TADROS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:415-844-9343
Mailing Address - Street 1:20 HAPPY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-9792
Mailing Address - Country:US
Mailing Address - Phone:415-844-9343
Mailing Address - Fax:
Practice Address - Street 1:450 SUTTER ST RM 1336
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4007
Practice Address - Country:US
Practice Address - Phone:415-844-9343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty