Individual
JUSTIN SURACHAI TANYAVUTTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
1918 BONITA AVE, BERKELEY, CA 94704
(703) 261-9973
Mailing address
PO BOX 2543, BERKELEY, CA 94702-0543
(847) 422-3654
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
178.010560
IL
101YP2500X
Professional Counselor
Primary
LPCC6651
CA
Other
Enumeration date
02/03/2015
Last updated
09/16/2019
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