Provider Demographics
NPI:1013655703
Name:MADE WHOLE PSYCHOTHERAPY SERVICES, INC.
Entity type:Organization
Organization Name:MADE WHOLE PSYCHOTHERAPY SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO, SR. THERAPIST
Authorized Official - Prefix:PROF
Authorized Official - First Name:OLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSAC, MSPC, LPCC
Authorized Official - Phone:707-642-5139
Mailing Address - Street 1:PO BOX 6691
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-1691
Mailing Address - Country:US
Mailing Address - Phone:707-642-5139
Mailing Address - Fax:707-641-1104
Practice Address - Street 1:1100 ROSE DRIVE
Practice Address - Street 2:SUITE 224
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3608
Practice Address - Country:US
Practice Address - Phone:707-642-5139
Practice Address - Fax:707-641-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty