Healthcare Provider Details

I. General information

NPI: 1407322050
Provider Name (Legal Business Name): HEALTHY MINDS HEALTHY BODY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CROW CANYON CT STE 225
SAN RAMON CA
94583-1740
US

IV. Provider business mailing address

18 CROW CANYON CT STE 225
SAN RAMON CA
94583-1740
US

V. Phone/Fax

Practice location:
  • Phone: 925-484-0074
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. THERESA VOLPE-JOHNSTONE
Title or Position: CLINICAL DIRECTOR
Credential: PHD
Phone: 925-484-0074