Provider Demographics
NPI:1174811665
Name:MENTAL HEALTH ASSOCIATION OF SAN MATEO
Entity type:Organization
Organization Name:MENTAL HEALTH ASSOCIATION OF SAN MATEO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLATTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-368-3345
Mailing Address - Street 1:6358 EL PASEO DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-5327
Mailing Address - Country:US
Mailing Address - Phone:408-691-5160
Mailing Address - Fax:
Practice Address - Street 1:2686 SPRING ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063
Practice Address - Country:US
Practice Address - Phone:650-368-3345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 7551251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health