Provider Demographics
NPI:1659740397
Name:THE RELATIONSHIP CLINIC
Entity Type:Organization
Organization Name:THE RELATIONSHIP CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE FAMILY THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOSTREL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:650-799-1375
Mailing Address - Street 1:139 REDLAND RD
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:94062-3732
Mailing Address - Country:US
Mailing Address - Phone:650-799-1375
Mailing Address - Fax:
Practice Address - Street 1:415 CAMBRIDGE AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1600
Practice Address - Country:US
Practice Address - Phone:650-799-1375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 27981251S00000X, 273R00000X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No251S00000XAgenciesCommunity/Behavioral Health
No283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT 27981OtherMARRIAGE FAMILY THERAPIST LICENSE
CAMFT 27981OtherLICENSE IN MARRIAGE FAMILY THERAPY