Healthcare Provider Details

I. General information

NPI: 1124665559
Provider Name (Legal Business Name): FLOURISH FAMILY WELLNESS PSYCHOLOGICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 16TH STREET SUITE 7
BAKERSFIELD CA
93301
US

IV. Provider business mailing address

3400 COTTAGE WAY SUITE G2 #1445
SACRAMENTO CA
95825
US

V. Phone/Fax

Practice location:
  • Phone: 661-368-8301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. HAILEY NICOLE HICKS
Title or Position: PRESIDENT AND DIRECTOR
Credential: PSY.D.
Phone: 661-368-8301