Provider Demographics
NPI: | 1639727514 |
---|---|
Name: | AROCKIA-DASS, JOSE THERESITA (LMFT) |
Entity Type: | Individual |
Prefix: | |
First Name: | JOSE THERESITA |
Middle Name: | |
Last Name: | AROCKIA-DASS |
Suffix: | |
Gender: | F |
Credentials: | LMFT |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 127 |
Mailing Address - Street 2: | |
Mailing Address - City: | NAPA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94559-0127 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 707-255-3300 |
Mailing Address - Fax: | 707-255-3527 |
Practice Address - Street 1: | 1555 PARKMOOR AVE |
Practice Address - Street 2: | |
Practice Address - City: | SAN JOSE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95128-2407 |
Practice Address - Country: | US |
Practice Address - Phone: | 408-282-0402 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2019-09-03 |
Last Update Date: | 2023-04-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101YM0800X | ||
CA | AMFT113681 | 106H00000X |
CA | 139096 | 106H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 139096 | Other | CALIFORNIA BOARD OF BEHAVIOR SCIENCES |