Most Relevant Information
Provider Data
| NPI Number: | 1003583220 |
| Provider Name: | PHOENIX SONG LMFT |
| Entity Type: | Individual |
| Taxonomy Code: | 106H00000X |
| Specialty: | Marriage & Family Therapist |
| License Number: | 109093 |
Most Important Dates
| Enumeration Date: | 08/25/2021 |
| Last Updated: | 12/27/2021 |
Provider Practice Location
1400 SHATTUCK AVE, STE 12
#228
BERKELEY
CA
947091411
Practice Location Phone/Fax
| Phone: | 4155458215 |
| Fax: |
Provider Mailing Location
1400 SHATTUCK AVE, STE 12
#228
BERKELEY
CA
947091411
Provider Mailing Phone/Fax
| Phone: | 4155458215 |
| Fax: |