Doctor Name: | JON MICHAEL FAXON |
NPI Number: | 1023131869 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | LCSW CA 24839 |
Business Practice Address: | 3840 Homestead Road Kaiser Permanete -- Behavioral Health Center Santa Clara, CA - 95051 |
Business Phone Number: | 4085692604 |
Business Fax Number: | |
Mailing Address: | 18951 Fernbrook Ct, SARATOGA |
State: | CA |
Postal Code: | 950703424 |
Phone Number: | 4085692604 |
Fax Number: | |
NPI Enumeration Date: | 04/09/2007 |
NPI Last Update Date: | 04/21/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LCSW CA 24839 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |