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Provider Information for 1144393638


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Mr. IVAN WILLIAM FOOTE L.M.F.T.


Sex: Male

NPI: 1144393638
Last Updated: 2007-07-08
Certification Date:

Details

NameValue
NPI1144393638
Enumeration Date2006-11-15
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address PO BOX 7814
SANTA CRUZ, CA 95061-7814
United States

Phone: 831-475-5826 | Fax:
 
Primary Practice Address 232 E GISH RD
SAN JOSE, CA 95112-4706
United States

Phone: 408-876-4104 | Fax:408-876-4230
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 106H00000X - Marriage & Family Therapist CAMFT36805