Provider Demographics
NPI:1043892565
Name:EVELINE WU MARRIAGE AND FAMILY THERAPIST INC
Entity Type:Organization
Organization Name:EVELINE WU MARRIAGE AND FAMILY THERAPIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:510-780-6960
Mailing Address - Street 1:2955 SHATTUCK AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1808
Mailing Address - Country:US
Mailing Address - Phone:510-479-0806
Mailing Address - Fax:
Practice Address - Street 1:2955 SHATTUCK AVE STE 9
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1808
Practice Address - Country:US
Practice Address - Phone:510-479-0806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)