Provider Demographics
NPI:1003150830
Name:WHOLE CHILD PSYCHOLOGICAL SERVICES, PC
Entity Type:Organization
Organization Name:WHOLE CHILD PSYCHOLOGICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:510-847-8797
Mailing Address - Street 1:2110 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2243
Mailing Address - Country:US
Mailing Address - Phone:510-847-8797
Mailing Address - Fax:
Practice Address - Street 1:2110 6TH ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2243
Practice Address - Country:US
Practice Address - Phone:510-847-8797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22017103K00000X, 251S00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency