Provider Demographics
NPI:1619275443
Name:ATLIS, MERA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:MERA
Middle Name:M
Last Name:ATLIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1453 MISSION ST
Mailing Address - Street 2:CIIS, PSYD PROGRAM
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2557
Mailing Address - Country:US
Mailing Address - Phone:510-260-7342
Mailing Address - Fax:
Practice Address - Street 1:1559B SLOAT BLVD
Practice Address - Street 2:PACIFICA PSYCHOLOGY #151
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1222
Practice Address - Country:US
Practice Address - Phone:510-260-7342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20777103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist