Provider Demographics
NPI:1205052008
Name:TOKIC-POLAK, BOSILJKA NADIA (MA, MFT)
Entity type:Individual
Prefix:MRS
First Name:BOSILJKA
Middle Name:NADIA
Last Name:TOKIC-POLAK
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 FAIRVIEW PLZ APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-5865
Mailing Address - Country:US
Mailing Address - Phone:408-395-4191
Mailing Address - Fax:
Practice Address - Street 1:240 WESTGATE DR # S-125
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2461
Practice Address - Country:US
Practice Address - Phone:831-425-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44133106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist