Provider Demographics
NPI:1558473538
Name:HOPE COUNSELING SERVICES
Entity Type:Organization
Organization Name:HOPE COUNSELING SERVICES
Other - Org Name:FAITH-HOPE COUNSELING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:RICHARDS-OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-763-9484
Mailing Address - Street 1:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94953
Mailing Address - Country:US
Mailing Address - Phone:707-763-9484
Mailing Address - Fax:707-763-8127
Practice Address - Street 1:941 B STREET
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952
Practice Address - Country:US
Practice Address - Phone:707-763-9484
Practice Address - Fax:707-763-8127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC2939103T00000X
CAMFC31829103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIMFT02939012OtherBLUE CROSS BLUE SHIELD
CAZZZ91211ZOtherBLUE CROSS
CAMFT04900POtherBLUE SHIELD