Provider Demographics
NPI:1558557660
Name:WESTIN, TOM (MFT)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:WESTIN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 PERKINS ST APT 105B
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4763
Mailing Address - Country:US
Mailing Address - Phone:510-485-6673
Mailing Address - Fax:510-982-5253
Practice Address - Street 1:2315 PRINCE ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1915
Practice Address - Country:US
Practice Address - Phone:510-224-5838
Practice Address - Fax:510-982-5253
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA50413106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty