Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 663 | CA |
N | 101YP2500X | Professional Counselor | 663 | CA |
N | 101YS0200X | School Counselor | 130139844 | CA |
N | 103K00000X | Behavior Analyst | 663 | CA |
NPI | 1083072722 |
---|---|
Provider Name | Ms. Kristin A. Phillips-Matson |
First Address | San Jose, CA 95118-2937 |
Second Address | Mountain View, CA 94040-2664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2016 |
Last Update Date | 09/02/2016 |