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Organization
KAISER PERMANENTE
Active
Organization
KAISER PERMANENTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACIE LEE KEPLER HOFFMAN (MFT)
(707) 645-2700
Entity
Organization
Contact information
Practice address
1761 BROADWAY ST, 100, VALLEJO, CA 94589-2226
(707) 645-2700
(707) 645-2181
Mailing address
1761 BROADWAY ST, 100, VALLEJO, CA 94589
(707) 645-2700
(707) 645-2181
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
MFC 47228
CA
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
MFC 47228
CA
Other
Enumeration date
12/23/2009
Last updated
12/23/2009
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