Organization
BIG DOG COUNSELING, INC.
Active
Organization
BIG DOG COUNSELING, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LOUISA PARKS PSY.D. (PRESIDENT)
(510) 427-7785
Entity
Organization
Contact information
Practice address
1683 NOVATO BLVD, SUITE 1B, NOVATO, CA 94947-3200
(510) 427-7785
(510) 625-0662
Mailing address
815 CREED RD, OAKLAND, CA 94610-1826
(510) 427-7785
(510) 625-0662
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY24459
CA
103TC0700X
Clinical Psychologist
PSY24459
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
816671
MEDICARE UIN
CA
01
—
FX694A
MEDICARE PTAN
CA
01
—
PSY24459
CA BOARD OF PSYCHOLOGY LICENSE NUMBER
CA
Enumeration date
07/07/2015
Last updated
08/25/2015
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