Basic Information
| Provider Information | |||||||||
| NPI: | 1578792081 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLAUSEN | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 37TH AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944034324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505732331 | ||||||||
| FaxNumber: | 6505732841 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 37TH AVE | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944034324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505732331 | ||||||||
| FaxNumber: | 6505732841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2009 | ||||||||
| LastUpdateDate: | 07/06/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC 21277 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.