Provider Demographics
NPI:1265907141
Name:KIND PSYCHOLOGICAL AND BEHAVIORAL SERVICES, INC.
Entity type:Organization
Organization Name:KIND PSYCHOLOGICAL AND BEHAVIORAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:KEENE
Authorized Official - Last Name:VISCOMI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, BCBA
Authorized Official - Phone:760-576-9931
Mailing Address - Street 1:1966 TICE VALLEY BLVD # 155
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-2203
Mailing Address - Country:US
Mailing Address - Phone:760-576-9931
Mailing Address - Fax:
Practice Address - Street 1:100 ROSE STREET
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94595-1341
Practice Address - Country:US
Practice Address - Phone:760-576-9931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-08
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty