1306433214 NPI number — THINK.GROW.INNOVATE. PSYCHOLOGICAL SERVICES PROF. CORP

Table of content: (NPI 1306433214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306433214 NPI number — THINK.GROW.INNOVATE. PSYCHOLOGICAL SERVICES PROF. CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THINK.GROW.INNOVATE. PSYCHOLOGICAL SERVICES PROF. CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THINK.GROW.INNOVATE. CONSULTING SERVICES LLC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306433214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 COTTAGE WAY
Provider Second Line Business Mailing Address:
SUTE G2 #3332
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2667 CAMINO DEL RIO S STE 210-3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-3707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-711-2659
Provider Business Practice Location Address Fax Number:
858-790-8300
Provider Enumeration Date:
12/26/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
LIZA
Authorized Official Middle Name:
JONES
Authorized Official Title or Position:
MEMBER/OWNER
Authorized Official Telephone Number:
877-711-2659

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)