Provider Demographics
NPI:1265067185
Name:OF TWO MINDS PSYCHOTHERAPY
Entity type:Organization
Organization Name:OF TWO MINDS PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KADE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLACH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:415-841-3338
Mailing Address - Street 1:PO BOX 110334
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95011-0334
Mailing Address - Country:US
Mailing Address - Phone:415-841-3338
Mailing Address - Fax:
Practice Address - Street 1:137 E HAMILTON AVE STE 205
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0244
Practice Address - Country:US
Practice Address - Phone:415-841-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106366OtherLMFT LICENSE NUMBER
CA1225412679OtherKATHLEEN FLACH'S NPI AS SOLE PROPRIETOR (BEFORE INCORPORATED AS OF TWO MINDS)