Provider Demographics
NPI:1558001206
Name:VIA PSYCHOLOGY, INC.
Entity Type:Organization
Organization Name:VIA PSYCHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBOI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:858-900-9393
Mailing Address - Street 1:2635 CAMINO DEL RIO S STE 302
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3729
Mailing Address - Country:US
Mailing Address - Phone:858-900-9393
Mailing Address - Fax:858-900-9393
Practice Address - Street 1:2635 CAMINO DEL RIO S STE 302
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3729
Practice Address - Country:US
Practice Address - Phone:858-900-9393
Practice Address - Fax:858-900-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health