Provider Demographics
NPI:1417674706
Name:MEN'S THERAPY CENTER
Entity Type:Organization
Organization Name:MEN'S THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:SIDEN
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:415-874-5652
Mailing Address - Street 1:230 CALIFORNIA AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1637
Mailing Address - Country:US
Mailing Address - Phone:858-442-6834
Mailing Address - Fax:
Practice Address - Street 1:230 CALIFORNIA AVE STE 107
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1637
Practice Address - Country:US
Practice Address - Phone:858-442-6834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health