Provider Demographics
NPI:1376815829
Name:COGNITIVE BEHAVIOR THERAPY CENTER ADULT & COUNSELING, INC.
Entity Type:Organization
Organization Name:COGNITIVE BEHAVIOR THERAPY CENTER ADULT & COUNSELING, INC.
Other - Org Name:COGNITIVE BEHAVIOR THERAPY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CENTER DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LC
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT/LPCC
Authorized Official - Phone:408-384-8404
Mailing Address - Street 1:900 E. HAMILTON AVE,
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008
Mailing Address - Country:US
Mailing Address - Phone:408-384-8404
Mailing Address - Fax:408-608-0484
Practice Address - Street 1:900 E. HAMILTON AVE,
Practice Address - Street 2:SUITE 100
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008
Practice Address - Country:US
Practice Address - Phone:408-384-8404
Practice Address - Fax:408-608-0484
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COGNITIVE BEHAVIOR THERAPY CENTER, ADULT AND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-30
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC-48807106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty