Healthcare Provider Details

I. General information

NPI: 1124949110
Provider Name (Legal Business Name): SERVE INSPIRE BUILD UPLIFT THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 TANOAK ST
HOLLISTER CA
95023-3129
US

IV. Provider business mailing address

590 TANOAK ST
HOLLISTER CA
95023-3129
US

V. Phone/Fax

Practice location:
  • Phone: 916-600-1529
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MICHAEL MARSHALL-SULLIVAN
Title or Position: COO
Credential:
Phone: 916-600-1529