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SOUTH DRIVE MEDICAL CLINIC NPI 1043248560


NPI Information

NPI: 1043248560
Provider Name: SOUTH DRIVE MEDICAL CLINIC
Classification: Psychologist - 103TC0700X
Entity Type: Organization

Specialization: Clinical

Address:
515 S DRIVE
#15
MOUNTAIN VIEW, CA
ZIP 94040
Phone: (650) 961-9430
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SOUTH DRIVE MEDICAL CLINIC is a clinical psychologist in Mountain View, CA. The provider is a psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems. SOUTH DRIVE MEDICAL CLINIC NPI is 1043248560. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

515 S DRIVE
#15
MOUNTAIN VIEW, CA
ZIP 94040-209
Phone: (650) 961-9430

The provider's authorized official is Kenneth S Peters .
The authorized official title is President and has the following contact phone number (650) 961-9430.

The enumeration date for this NPI number is 6/30/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1103TC0700XPsychologistClinicalPSY4724CALIFORNIAYes
2207R00000XInternal MedicineG33788CALIFORNIAX

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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