Healthcare Provider Details

I. General information

NPI: 1740101823
Provider Name (Legal Business Name): ACTION POTENTIAL PSYCHOLOGICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

858 S BARLOW LN
BISHOP CA
93514-3144
US

IV. Provider business mailing address

858 S BARLOW LN
BISHOP CA
93514-3144
US

V. Phone/Fax

Practice location:
  • Phone: 760-920-6007
  • Fax:
Mailing address:
  • Phone: 760-920-6007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JACOB EIDE
Title or Position: OWNER, CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 206-407-7930