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Organization
KAISER SANTA THERESA PSYCHIATRY DEPT
Active
Organization
KAISER SANTA THERESA PSYCHIATRY DEPT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHANNON B MICHELSON LCSW (THERAPIST)
(408) 972-3419
Entity
Organization
Contact information
Practice address
5755 COTTLE RD, BUILDING 4, SAN JOSE, CA 95014
(408) 972-3419
Mailing address
P O BOX 5956, SAN JOSE, CA 95150
(408) 972-3419
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
LCS21247
CA
Other
Enumeration date
02/28/2007
Last updated
08/22/2020
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