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General NPI Number Information
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NPI Number | 1124665559
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Entity Type | Organization
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Legal Business Name | FLOURISH FAMILY WELLNESS PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 12/04/2019
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Last Update Date | 12/04/2019
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Provider Practice Location Address
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Address Line | 1909 16TH STREET SUITE 7
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City | BAKERSFIELD
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State | CA
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Zip | 93301
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Country | US
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Telephone | 661-368-8301
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 COTTAGE WAY SUITE G2 #1445
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City | SACRAMENTO
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State | CA
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Zip | 95825
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND DIRECTOR
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Name | DR. HAILEY NICOLE HICKS
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Credential | PSY.D.
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Telephone | 661-368-8301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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