Provider Demographics
NPI:1841749314
Name:ABEYATUNGE, KRISHAN (MFT)
Entity Type:Individual
Prefix:
First Name:KRISHAN
Middle Name:
Last Name:ABEYATUNGE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1540
Mailing Address - Country:US
Mailing Address - Phone:415-820-1460
Mailing Address - Fax:
Practice Address - Street 1:1300 25TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-1540
Practice Address - Country:US
Practice Address - Phone:415-820-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPC48983101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health