JUSTIN SURACHAI TANYAVUTTI (NPI# 1538559166) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538559166 |
| Entity Type | Individual |
| Full Name | JUSTIN SURACHAI TANYAVUTTI |
| Credential | LPCC |
| Practice Address |
1918 Bonita Ave Berkeley CA 94704 |
| Mailing Address |
Po Box 2543 Berkeley CA 94702-0543 |
| Practice Telephone | 7032619973 |
| Mailing Telephone | 8474223654 |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2019-09-16 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
LPCC6651 | CA | Behavioral Health & Social Service Providers |
| N | 101YP2500X |
Counselor Specialization: Professional |
178.010560 | IL | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 5225 Old Orchard Rd, Suite 37, Skokie, IL 600774405 | 8475298300 |
| Street Address |
1918 BONITA AVE |
| City | BERKELEY |
| State | CA |
| Zip Code | 94704 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275741167 | Altaf A Bhimji | Social Worker | 1918 Bonita Ave, Berkeley, CA 94704-1014 | 2007-05-21 |
| 1326517145 | Kelly Anne Bassin | Counselor | 1918 Bonita Ave, Berkeley, CA 94704-1014 | 2018-11-21 |
| 1558887182 | Katey Nicolai | Psychologist | 1918 Bonita Ave, Berkeley, CA 94704-1014 | 2017-08-15 |
| 1578008710 | Madeline Razavi | Social Worker | 1918 Bonita Ave, Berkeley, CA 94704-1014 | 2016-12-26 |
| 1053687319 | Shari Gleicher | Social Worker | 1918 Bonita Ave, Berkeley, CA 94704-1014 | 2012-03-30 |
| 1902121262 | Kathleen Erin Brady | Social Worker | 1918 Bonita Ave, Berkeley, CA 94704 | 2010-03-30 |
| 1730401514 | Alexander Joseph Lapinski | Psychologist | 1918 Bonita Ave, Berkeley, CA 94704-1014 | 2010-02-22 |
| 1578711248 | Ezrimayr Chioma | Marriage & Family Therapist | 1918 Bonita Ave, Berkeley, CA 94704-1014 | 2008-09-05 |
| 1326228586 | Tracy L Davis | Social Worker | 1918 Bonita Ave, Berkeley, CA 94704-1014 | 2007-11-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821698887 | Ka Yin Emma Liu | Counselor | 1936 University Avenue, Partnerships for Trauma Recover, Suite 191, Berkeley, CA 94704 | 2020-10-29 |
| 1821617168 | Michelle Nagal Hunt | Behavior Technician | 2080 Addison Street, #302, Berkeley, CA 94704 | 2020-04-15 |
| 1366097081 | Sabrina Barnett | Behavior Technician | 2080 Addison St, #302, Berkeley, CA 94704 | 2019-08-08 |
| 1811559735 | Bonita House, Inc. | Community/Behavioral Health | 1909 University Ave, Berkeley, CA 94704 | 2019-07-01 |
| 1376014928 | Justin T Cooke | Specialist/Technologist | 2024 Durant Ave #508, Berkeley, CA 94704 | 2018-12-07 |
| 1972080158 | Cecilia Winfield | Student in an Organized Health Care Education/Training Program | 1918 University Ave., Suite 2b, Berkeley, CA 94704 | 2018-07-20 |
| 1952897332 | Jennifer Henry Henry | Naturopath | 2041 Bancroft Way #303, 2041 Bancroft Way, Berkeley, CA 94704 | 2018-07-09 |
| 1497267967 | Merlenet Michelle Riley | Counselor | 2640 Martin Luther King, Berkeley, CA 94704 | 2017-10-24 |
| 1265951719 | Caitlin Mary Mcdonough | Student in an Organized Health Care Education/Training Program | 1918 University Avenue, Suite 2b, Berkeley, CA 94704 | 2017-09-15 |
| 1922525120 | Patrice Werling | Counselor | 1918 University Avenue, Suite 2b, Berkeley, CA 94704 | 2017-08-28 |
| Find all providers in zip 94704 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831796978 | Geri Ann Delarosa | Counselor | 1521a Shattuck Ave, Berkeley, CA 94709-1516 | 2020-10-01 |
| 1003318296 | Olivia Fadul | Counselor | 14 Alvarado Pl, Berkeley, CA 94705-1507 | 2018-03-02 |
| 1144580960 | Benjamin Tucker | Counselor | 2625 Alcatraz Ave Ste 609, Berkeley, CA 94705 | 2012-05-26 |
| 1588978688 | St. Louis County Government | Counselor | 4201 Mckibbon Rd, Berkeley, MO 63134-3217 | 2010-07-30 |
| 1023209004 | Aaron R Testard I | Counselor | 2006 Dwight Way Ste 103, Berkeley, CA 94704-2633 | 2007-08-06 |
| 1457568156 | Merrie Sennett | Counselor | 1442a Walnut St # 194, Berkeley, CA 94709-1405 | 2007-05-16 |
| 1326194911 | John Anthony Dedomenico | Counselor | 2020 Blake St, Berkeley, CA 94704 | 2007-01-26 |
| 1417577586 | Crystal Haviland | Counselor | 3001 Dana St, Berkeley, CA 94705-2041 | 2020-04-19 |
| 1265945844 | Open Spectrum Behavior Therapy | Counselor | 2625 Alcatraz Ave Ste 609, Berkeley, CA 94705 | 2017-11-06 |
| 1073864534 | Zvi Jeremy Bellin | Counselor | 2915 Martin Luther King Jr Way, Berkeley, CA 94703-2133 | 2012-09-25 |
| Find all providers in BERKELEY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.