Provider Demographics
NPI:1659536431
Name:INDEPENDENCE BLVD COUNSELING SERVICES
Entity Type:Organization
Organization Name:INDEPENDENCE BLVD COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRALL-CATRON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:661-859-0628
Mailing Address - Street 1:1701 WESTWIND DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3048
Mailing Address - Country:US
Mailing Address - Phone:661-859-0628
Mailing Address - Fax:661-859-0629
Practice Address - Street 1:1701 WESTWIND DR
Practice Address - Street 2:SUITE 208
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3048
Practice Address - Country:US
Practice Address - Phone:661-859-0628
Practice Address - Fax:661-859-0629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty