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General NPI Number Information
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NPI Number | 1265907141
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Entity Type | Organization
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Legal Business Name | KIND PSYCHOLOGICAL AND BEHAVIORAL SERVICES, INC.
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Dates
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Enumeration Date | 10/08/2018
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Last Update Date | 06/04/2019
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Provider Practice Location Address
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Address Line | 100 ROSE STREET
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City | WALNUT CREEK
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State | CA
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Zip | 94595-1341
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Country | US
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Telephone | 760-576-9931
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Fax |
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Provider Business Mailing Address
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Address Line | 1966 TICE VALLEY BLVD # 155
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City | WALNUT CREEK
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State | CA
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Zip | 94595-2203
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Country | US
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Telephone | 760-576-9931
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. COURTNEY KEENE VISCOMI
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Credential | PSYD, BCBA
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Telephone | 760-576-9931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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