Provider Demographics
NPI:1841058534
Name:BOTAITIS THERAPY GROUP CORPORATION
Entity type:Organization
Organization Name:BOTAITIS THERAPY GROUP CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOTAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT & LPCC
Authorized Official - Phone:805-636-9890
Mailing Address - Street 1:817 GARDEN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-7473
Mailing Address - Country:US
Mailing Address - Phone:805-636-9890
Mailing Address - Fax:
Practice Address - Street 1:817 GARDEN ST STE 200
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-7473
Practice Address - Country:US
Practice Address - Phone:805-636-9890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)