Provider Demographics
NPI:1629410022
Name:KAIROS PSYCHOLOGY PC
Entity Type:Organization
Organization Name:KAIROS PSYCHOLOGY PC
Other - Org Name:KAIROS COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-874-8463
Mailing Address - Street 1:790 MASON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4661
Mailing Address - Country:US
Mailing Address - Phone:707-874-8463
Mailing Address - Fax:707-455-6026
Practice Address - Street 1:790 MASON ST STE 102
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4661
Practice Address - Country:US
Practice Address - Phone:707-874-8463
Practice Address - Fax:707-455-6026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21927103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty