Provider Demographics
NPI:1295015030
Name:ECHO ROCK THERAPY CENTER, 501(C) 3
Entity Type:Organization
Organization Name:ECHO ROCK THERAPY CENTER, 501(C) 3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:415-302-4858
Mailing Address - Street 1:45 CAMINO ALTO
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2929
Mailing Address - Country:US
Mailing Address - Phone:415-302-4858
Mailing Address - Fax:415-737-1389
Practice Address - Street 1:45 CAMINO ALTO
Practice Address - Street 2:SUITE 200
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2929
Practice Address - Country:US
Practice Address - Phone:415-302-4858
Practice Address - Fax:415-737-1389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29744106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty