Provider Demographics
NPI:1043058001
Name:BOUNTIFUL HEALTH FAMILY THERAPY INC
Entity type:Organization
Organization Name:BOUNTIFUL HEALTH FAMILY THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KACIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-232-4446
Mailing Address - Street 1:PO BOX 13244
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-5090
Mailing Address - Country:US
Mailing Address - Phone:949-232-4446
Mailing Address - Fax:
Practice Address - Street 1:1990 N CALIFORNIA BLVD FL 8
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3742
Practice Address - Country:US
Practice Address - Phone:949-232-4446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty