Provider Demographics
NPI:1083332803
Name:OCTAVE BEHAVIORAL PA
Entity Type:Organization
Organization Name:OCTAVE BEHAVIORAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, REVENUE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KYM
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-360-3861
Mailing Address - Street 1:625 MARKET ST FL 15
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-3316
Mailing Address - Country:US
Mailing Address - Phone:415-360-3861
Mailing Address - Fax:628-234-3076
Practice Address - Street 1:211 E 7TH ST STE 620
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-3218
Practice Address - Country:US
Practice Address - Phone:415-360-3878
Practice Address - Fax:628-234-3087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty