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Provider Information for 1194116400

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1194116400

Calendar   Last Updated:  2021-01-08
  Certification Date:  2021-01-08


Name Value
NPI 1194116400
Enumeration Date 2015-02-09
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 16782 VON KARMAN AVE STE 11
IRVINE, CA 92606-2417
United States

Phone: 619-550-6368 | Fax:
View Map External Link
Primary Practice Address 1425 N MCDOWELL BLVD STE 206
PETALUMA, CA 94954-6525
United States

Phone: 855-223-7123 | Fax: 714-784-7516
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Secondary Practice Address 2275 ARLINGTON DR
SAN LEANDRO, CA 94578-1132
United States

Phone: 510-317-1444 | Fax:
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Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 103K00000X - Behavioral Analyst
No 101Y00000X - Counselor