Basic Information
| Provider Information | |||||||||
| NPI: | 1538204672 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDREN'S HEALTH COUNCIL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 CLARK WAY | ||||||||
| Address2: | |||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943042300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503265530 | ||||||||
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| Practice Location | |||||||||
| Address1: | 650 CLARK WAY | ||||||||
| Address2: | |||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943042300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503265530 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LEE-ANCAJAS | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | STAFF PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 6503263350 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | PSY15673 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.