Provider Demographics
NPI:1467839589
Name:KWAN, MABEL TAI (AMFT)
Entity Type:Individual
Prefix:MRS
First Name:MABEL
Middle Name:TAI
Last Name:KWAN
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:MRS
Other - First Name:MABEL
Other - Middle Name:
Other - Last Name:KWAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:310 8TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-6527
Mailing Address - Country:US
Mailing Address - Phone:510-735-3900
Mailing Address - Fax:510-735-3941
Practice Address - Street 1:310 8TH ST STE 201
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-6527
Practice Address - Country:US
Practice Address - Phone:510-735-3900
Practice Address - Fax:510-735-3941
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA118239106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist