Provider Demographics
NPI:1699546390
Name:BAOBAB PSYCHOLOGY LLC
Entity type:Organization
Organization Name:BAOBAB PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:360-207-3439
Mailing Address - Street 1:3906 S 74TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-1005
Mailing Address - Country:US
Mailing Address - Phone:360-207-3439
Mailing Address - Fax:
Practice Address - Street 1:3906 S 74TH ST STE 201
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-1005
Practice Address - Country:US
Practice Address - Phone:360-207-3439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health