Provider Demographics
NPI:1518269372
Name:PSYCHIATRIC ALTERNATIVES AND WELLNESS CENTER
Entity Type:Organization
Organization Name:PSYCHIATRIC ALTERNATIVES AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIEGER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:415-237-0377
Mailing Address - Street 1:2010 EDDY ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3998
Mailing Address - Country:US
Mailing Address - Phone:415-237-0377
Mailing Address - Fax:415-484-1944
Practice Address - Street 1:2010 EDDY ST
Practice Address - Street 2:SUITE C
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3998
Practice Address - Country:US
Practice Address - Phone:415-237-0377
Practice Address - Fax:415-484-1944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23643103TC0700X
CAPSY15510103TC0700X
CA24348103TC0700X
CA23822103TC0700X
CA23653103TC0700X
CA23805103TC0700X
CA23643103TC0700X
CA23785103TC0700X
CA24678103TC0700X
CAA841072084P0800X
CAA811242084P0800X
CAA629862084P0804X
CAG643802084P0804X
CAA1061402084P0804X
CAA535292084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA106140OtherLICENSE NUMBER