Basic Information
| Provider Information | |||||||||
| NPI: | 1770935819 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTER FOR PSYCHOTHERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 509 W 10TH ST | ||||||||
| Address2: | |||||||||
| City: | ANTIOCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945091653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9257779540 | ||||||||
| FaxNumber: | 9257579024 | ||||||||
| Practice Location | |||||||||
| Address1: | 509 W 10TH ST | ||||||||
| Address2: | |||||||||
| City: | ANTIOCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945091653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9257779540 | ||||||||
| FaxNumber: | 9257579024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2016 | ||||||||
| LastUpdateDate: | 08/30/2016 | ||||||||
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| AuthorizedOfficialLastName: | ROBINSON | ||||||||
| AuthorizedOfficialFirstName: | WESLEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9256283556 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251V00000X | PSY15066 | CA | N | Agencies | Voluntary or Charitable | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.