Provider Demographics
NPI:1679775050
Name:SALEME, MYRTHA DE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:MYRTHA
Middle Name:DE
Last Name:SALEME
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 SARATOGA AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-4900
Mailing Address - Country:US
Mailing Address - Phone:408-865-0230
Mailing Address - Fax:408-865-0230
Practice Address - Street 1:1475 SARATOGA AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-4900
Practice Address - Country:US
Practice Address - Phone:408-865-0230
Practice Address - Fax:408-865-0230
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 31040106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist