Tanyavutti, Justin Surachai

Tanyavutti, Justin Surachai is an sole proprietor health care provider with primary practice located at 1918 Bonita Ave , Berkeley CA 94704. He recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as his primary health care specialty. Tanyavutti, Justin Surachai can be contacted via phone (703) 261-9973.

Contact Information

Primary practice address
1918 Bonita Ave Berkeley CA 94704
Phone: (703) 261-9973
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 178.010560 Illinois
Behavioral Health & Social Service Providers / Professional 101YP2500X LPCC6651 California

Profile Details

NPI number 1538559166
LBN Legal business name Tanyavutti, Justin Surachai
Credentials LPCC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 3rd, 2015
Last updated Sep 16th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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