Provider Demographics
NPI:1730795337
Name:FULL CIRCLE PSYCHOTHERAPY
Entity type:Organization
Organization Name:FULL CIRCLE PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORINNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARROWS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW 96438
Authorized Official - Phone:510-326-3959
Mailing Address - Street 1:6741 SEBASTOPOL AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3838
Mailing Address - Country:US
Mailing Address - Phone:510-326-3959
Mailing Address - Fax:
Practice Address - Street 1:6741 SEBASTOPOL AVE STE 110
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3838
Practice Address - Country:US
Practice Address - Phone:510-326-3959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1093323669Medicaid
CA1619483260Medicaid