NPIMap

Organization Active NPI

Buckelew Program

  • Mental Health Counselor
  • San Rafael, CA
National Provider Identifier
1649587874
Registry record updated Sep 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
BUCKELEW PROGRAM
Practice address
900 5TH Ave
San Rafael, CA 94901-2959
Phone
(415) 457-6964
NPI assigned
Sep 9, 2010
Last updated
Sep 9, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Katy Spense
Title
Senior Site Manager
Phone
(415) 457-6964

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

900 5TH Ave
San Rafael, CA 94901-2959

Mailing address

900 5TH Ave
San Rafael, CA 94901-2959
Phone (415) 457-6964

National Provider Directory

National Provider Directory
Tax ID family
Rosita'119 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 16

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 16

Locations

900 5th Ave
San Rafael, CA 94901
Phone (707) 253-1009

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1283990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283990400000",
    "number": "1649587874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 5TH AVE",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012959",
            "telephone_number": "415-457-6964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 5TH AVE",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012959",
            "telephone_number": "415-457-6964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUCKELEW PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-09",
        "last_updated": "2010-09-09",
        "status": "A",
        "authorized_official_last_name": "SPENSE",
        "authorized_official_first_name": "KATY",
        "authorized_official_title_or_position": "SENIOR SITE MANAGER",
        "authorized_official_telephone_number": "415-457-6964",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.