Healthcare Provider Details

I. General information

NPI: 1265907141
Provider Name (Legal Business Name): KIND PSYCHOLOGICAL AND BEHAVIORAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ROSE STREET
WALNUT CREEK CA
94595-1341
US

IV. Provider business mailing address

1966 TICE VALLEY BLVD # 155
WALNUT CREEK CA
94595-2203
US

V. Phone/Fax

Practice location:
  • Phone: 760-576-9931
  • Fax:
Mailing address:
  • Phone: 760-576-9931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: DR. COURTNEY KEENE VISCOMI
Title or Position: PRESIDENT
Credential: PSYD, BCBA
Phone: 760-576-9931