| Made Whole Psychotherapy Services, Inc. | |
|
1100 Rose Drive Suite 224 Benicia CA 94510-3608 | |
| (707) 642-5139 | |
| (707) 641-1104 |
| Full Name | Made Whole Psychotherapy Services, Inc. |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 1100 Rose Drive, Benicia, California |
| Authorized Official Name and Position | Ollis Carver (CEO, SR. THERAPIST) |
| Authorized Official Contact | 7076425139 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Made Whole Psychotherapy Services, Inc. Po Box 6691 Vallejo CA 94591-1691 Ph: (707) 642-5139 | Made Whole Psychotherapy Services, Inc. 1100 Rose Drive Suite 224 Benicia CA 94510-3608 Ph: (707) 642-5139 |
| NPI Number | 1013655703 |
|---|---|
| Provider Enumeration Date | 05/23/2022 |
| Last Update Date | 11/17/2023 |
| Certification Date | 11/17/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013655703 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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