Healthcare Provider Details

I. General information

NPI: 1427216167
Provider Name (Legal Business Name): COUNSELING & PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 NORTH HALL
DAVIS CA
95616
US

IV. Provider business mailing address

1 SHIELDS AVE
DAVIS CA
95616-5270
US

V. Phone/Fax

Practice location:
  • Phone: 530-752-0871
  • Fax: 530-752-9923
Mailing address:
  • Phone: 530-752-0871
  • Fax: 530-752-9923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY8989
License Number StateCA

VIII. Authorized Official

Name: EMIL RODOLFA
Title or Position: DIRECTOR
Credential: PHD
Phone: 530-752-0871