Healthcare Provider Details

I. General information

NPI: 1346457157
Provider Name (Legal Business Name): COMMUNITY COUNSELING SERVICES CHILD COUNSELOR A PROF CORP DEAN HADDOCK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 CALIFORNIA AVE 330-B
BAKERSFIELD CA
93309-7024
US

IV. Provider business mailing address

PO BOX 82096
BAKERSFIELD CA
93380-2096
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-8167
  • Fax: 661-326-8221
Mailing address:
  • Phone: 661-326-8167
  • Fax: 661-326-8221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY 8536
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY 8536
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY 8536
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY 8536
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPSY 8536
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberPSY 8536
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY 8536
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMI 13954
License Number StateCA
# 9
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 8536
License Number StateCA

VIII. Authorized Official

Name: DR. MCCOY DEAN HADDOCK
Title or Position: CEO
Credential: PSY.D.
Phone: 661-326-8167