Provider Demographics
NPI:1215286604
Name:SENK, ILANA GOLDACH (MFTI)
Entity type:Individual
Prefix:
First Name:ILANA
Middle Name:GOLDACH
Last Name:SENK
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1153
Mailing Address - Country:US
Mailing Address - Phone:415-518-0960
Mailing Address - Fax:
Practice Address - Street 1:32 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1153
Practice Address - Country:US
Practice Address - Phone:415-518-0960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72164101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health