MEDICARE: VALLEY PSYCHOLOGICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	PSY16717	CA
2	101YP2500X	Professional Counselor	PSY16717	CA
3	103TB0200X	Cognitive & Behavioral Psychologist	PSY16717	CA
4	103TC2200X	Clinical Child & Adolescent Psychologist	PSY16717	CA
5	103TF0000X	Family Psychologist	PSY16717	CA
6	103TP2701X	Group Psychotherapy Psychologist	PSY16717	CA
7	106H00000X	Marriage & Family Therapist	PSY16717	CA
8	103T00000X	Psychologist	PSY16717	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1184867962	OTHER	CA	NPI NUMBER

General Provider Information

NPI Number	:	1508204082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY PSYCHOLOGICAL CENTER

Provider Business Mailing Address
First Line	:	3411 3RD AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-4906
Country	:	US
Telephone Number	:	619-203-5336
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 W MAIN ST
Second Line	:	SUITE B
City	:	EL CENTRO
State	:	CA
Zip	:	92243-2198
Country	:	US
Telephone Number	:	760-352-9090
Fax Number	:	760-352-9920

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	MRS. STACEY HOYT
Credential	:	PHD.
Telephone Number	:	619-203-5336

Provider Enumeration Date	:	06/06/2013
Last Update Date	:	06/06/2013

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Directions to “VALLEY PSYCHOLOGICAL CENTER ” Practice Location

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