Basic Information
| Provider Information | |||||||||
| NPI: | 1669870663 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OPTIONS RECOVERY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1931 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947041105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106669552 | ||||||||
| FaxNumber: | 5106660987 | ||||||||
| Practice Location | |||||||||
| Address1: | 1835 ALLSTON WAY | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947041764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106669552 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2014 | ||||||||
| LastUpdateDate: | 07/27/2015 | ||||||||
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| AuthorizedOfficialLastName: | GORHAM | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5106669552 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MFT, CDACII | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 00 | 01 | CA | 00 | OTHER |