Provider Demographics
NPI:1841951399
Name:MAHNAMANA PSYCHOTHERAPY AND MEDITATION
Entity type:Organization
Organization Name:MAHNAMANA PSYCHOTHERAPY AND MEDITATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TUCKER
Authorized Official - Middle Name:
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-485-9411
Mailing Address - Street 1:2103 SAN JOSE AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4994
Mailing Address - Country:US
Mailing Address - Phone:520-485-9411
Mailing Address - Fax:
Practice Address - Street 1:2258 SANTA CLARA AVE STE 5
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4473
Practice Address - Country:US
Practice Address - Phone:415-802-2860
Practice Address - Fax:844-227-8699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty