| Therapeutic Integrative Psychotherapy Clinic, Inc. | |
|
2171 14th Ave San Francisco CA 94116-1840 | |
| (323) 445-8900 | |
| (323) 345-5778 |
| Full Name | Therapeutic Integrative Psychotherapy Clinic, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 2171 14th Ave, San Francisco, California |
| Authorized Official Name and Position | Alan B Goodwin (PRESIDENT) |
| Authorized Official Contact | 3234458900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Therapeutic Integrative Psychotherapy Clinic, Inc. 14320 Ventura Blvd # 1129 Sherman Oaks CA 91423-2717 Ph: (323) 445-8900 | Therapeutic Integrative Psychotherapy Clinic, Inc. 2171 14th Ave San Francisco CA 94116-1840 Ph: (323) 445-8900 |
| NPI Number | 1427504281 |
|---|---|
| Provider Enumeration Date | 08/31/2016 |
| Last Update Date | 12/03/2024 |
| Certification Date | 12/03/2024 |
| Medicare PECOS PAC ID | 2365720976 |
|---|---|
| Medicare Enrollment ID | O20161102002580 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427504281 | NPI | - | NPPES |
| 1184002156 | Other | CA | NPI TYPE 1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Alan B Goodwin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184002156 PECOS PAC ID: 5193012888 Enrollment ID: I20161102002842 |
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