Provider Demographics
NPI:1124665559
Name:FLOURISH FAMILY WELLNESS PSYCHOLOGICAL SERVICES, INC.
Entity type:Organization
Organization Name:FLOURISH FAMILY WELLNESS PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAILEY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:661-368-8301
Mailing Address - Street 1:3400 COTTAGE WAY
Mailing Address - Street 2:SUITE G2 #1445
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1909 16TH STREET
Practice Address - Street 2:SUITE 7
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301
Practice Address - Country:US
Practice Address - Phone:661-368-8301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty