Provider Demographics
NPI:1386949584
Name:NOVATA BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:NOVATA BEHAVIORAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:858-573-2600
Mailing Address - Street 1:10065 OLD GROVE RD
Mailing Address - Street 2:#200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1664
Mailing Address - Country:US
Mailing Address - Phone:858-566-6439
Mailing Address - Fax:
Practice Address - Street 1:10065 OLD GROVE RD
Practice Address - Street 2:#200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1664
Practice Address - Country:US
Practice Address - Phone:858-566-6439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty