Healthcare Provider Details

I. General information

NPI: 1134668932
Provider Name (Legal Business Name): OLFORD-EDDY PSYCHOLOGICAL SERVICES GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 W SHAW AVE STE 200
FRESNO CA
93704-2515
US

IV. Provider business mailing address

516 W SHAW AVE STE 200
FRESNO CA
93704-2515
US

V. Phone/Fax

Practice location:
  • Phone: 559-593-2013
  • Fax:
Mailing address:
  • Phone: 559-593-2013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberNO NUMBER PROVIDED
License Number StateIL

VIII. Authorized Official

Name: MR. STEVEN MARK EDDY
Title or Position: DIRECTOR PRESIDENT
Credential: REV
Phone: 559-593-2013