Provider Demographics
NPI:1003695362
Name:WEEKEND THERAPY PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:WEEKEND THERAPY PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:WEEKEND THERAPY L.L.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:805-203-6673
Mailing Address - Street 1:2035 N PUMP HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-8022
Mailing Address - Country:US
Mailing Address - Phone:805-203-6673
Mailing Address - Fax:805-800-8929
Practice Address - Street 1:2035 N PUMP HOUSE LN
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-8022
Practice Address - Country:US
Practice Address - Phone:805-225-4446
Practice Address - Fax:805-800-8929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty