Provider Demographics
NPI:1013332725
Name:PSYCHTOOLS PSYCHOLOGY GROUP P.C.
Entity Type:Organization
Organization Name:PSYCHTOOLS PSYCHOLOGY GROUP P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:VIGIL DOMBECK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:510-900-5123
Mailing Address - Street 1:1402 PARK ST STE G
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4562
Mailing Address - Country:US
Mailing Address - Phone:510-900-5123
Mailing Address - Fax:888-974-4218
Practice Address - Street 1:1402 PARK ST
Practice Address - Street 2:SUITE G
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4554
Practice Address - Country:US
Practice Address - Phone:510-900-5123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25695103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty