Provider Demographics
NPI:1548033590
Name:SILENT HILLS FAMILY THERAPIST CORPORATIOM
Entity type:Organization
Organization Name:SILENT HILLS FAMILY THERAPIST CORPORATIOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:925-426-4729
Mailing Address - Street 1:PO BOX 5536
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-0536
Mailing Address - Country:US
Mailing Address - Phone:925-426-4729
Mailing Address - Fax:
Practice Address - Street 1:2955 SHATTUCK AVE STE 2955
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1808
Practice Address - Country:US
Practice Address - Phone:925-426-4729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty