# KAISER SANTA THERESA PSYCHIATRY DEPT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902933476
- **Authorized official:** MS. SHANNON B MICHELSON LCSW (THERAPIST)
- **Authorized official phone:** (408) 972-3419

## Contact information

- **Practice address:** 5755 COTTLE RD, BUILDING 4, SAN JOSE, CA 95014
- **Practice address phone:** (408) 972-3419
- **Mailing address:** P O BOX 5956, SAN JOSE, CA 95150
- **Mailing address phone:** (408) 972-3419

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | LCS21247 | CA | Yes |

## Other

- **Enumeration date:** 02/28/2007
- **Last updated:** 08/22/2020