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Organization
INDIVIDUAL APPLICATION
Active
Organization
INDIVIDUAL APPLICATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEGAN BRUBAKER (MFT INTERN)
(530) 276-1952
Entity
Organization
Contact information
Practice address
86 PERALTA AVE, SAN FRANCISCO, CA 94110-4841
(530) 276-1952
Mailing address
86 PERALTA AVE, SAN FRANCISCO, CA 94110-4841
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
06/22/2016
Last updated
06/22/2016
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