Provider Demographics
NPI:1437580073
Name:BAY AREA GESTALT INSTITUTE
Entity Type:Organization
Organization Name:BAY AREA GESTALT INSTITUTE
Other - Org Name:BAGI
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:415-689-6422
Mailing Address - Street 1:255 EASY ST
Mailing Address - Street 2:SUITE 13
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-3763
Mailing Address - Country:US
Mailing Address - Phone:415-689-6422
Mailing Address - Fax:
Practice Address - Street 1:255 EASY ST
Practice Address - Street 2:SUITE 13
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-3763
Practice Address - Country:US
Practice Address - Phone:415-689-6422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106H00000XOtherNONE