Provider Demographics
NPI:1891109476
Name:BRAVO, VIVIAN WAN (LMFT, LPCC)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:WAN
Last Name:BRAVO
Suffix:
Gender:F
Credentials:LMFT, LPCC
Other - Prefix:MS
Other - First Name:SIN YAN
Other - Middle Name:
Other - Last Name:WAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1650 MISSION ST FL 5
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2414
Mailing Address - Country:US
Mailing Address - Phone:415-355-3690
Mailing Address - Fax:
Practice Address - Street 1:1650 MISSION ST FL 5
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2414
Practice Address - Country:US
Practice Address - Phone:415-355-3690
Practice Address - Fax:415-355-3683
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7469101YP2500X
CAMFTI 93927106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional