Provider Demographics
NPI:1760031314
Name:THE HEALTHY TEEN PROJECT, INC.
Entity Type:Organization
Organization Name:THE HEALTHY TEEN PROJECT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:BREHME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-900-8464
Mailing Address - Street 1:919 FREMONT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-6047
Mailing Address - Country:US
Mailing Address - Phone:650-941-2300
Mailing Address - Fax:650-941-2305
Practice Address - Street 1:1400 TENNESSEE ST UNIT 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-3421
Practice Address - Country:US
Practice Address - Phone:415-797-1414
Practice Address - Fax:415-797-1413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health