Provider Demographics
NPI:1649591231
Name:BOLLINGER, TODD ALLEN (PSYD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ALLEN
Last Name:BOLLINGER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 BRIDGEWAY BLVD.
Mailing Address - Street 2:SUITE-K #125
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965
Mailing Address - Country:US
Mailing Address - Phone:805-234-0025
Mailing Address - Fax:
Practice Address - Street 1:3001 BRIDGEWAY
Practice Address - Street 2:SUITE-K #125
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1408
Practice Address - Country:US
Practice Address - Phone:805-234-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23129103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic