Provider Demographics
NPI:1932799111
Name:BERKELEY HOLISTIC THERAPY, A MARRIAGE AND FAMILY THERAPY CORPORATION
Entity Type:Organization
Organization Name:BERKELEY HOLISTIC THERAPY, A MARRIAGE AND FAMILY THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:VECHAKUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-316-2503
Mailing Address - Street 1:2342 SHATTUCK AVE UNIT 879
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1517
Mailing Address - Country:US
Mailing Address - Phone:510-545-3360
Mailing Address - Fax:
Practice Address - Street 1:1500 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2020
Practice Address - Country:US
Practice Address - Phone:510-545-3350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty