Healthcare Provider Details

I. General information

NPI: 1073742854
Provider Name (Legal Business Name): JEAN GEHRICKE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19722 MACARTHUR BLVD
IRVINE CA
92612-2404
US

IV. Provider business mailing address

19722 MACARTHUR BLVD
IRVINE CA
92612-2404
US

V. Phone/Fax

Practice location:
  • Phone: 949-212-1668
  • Fax:
Mailing address:
  • Phone: 949-212-1668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY22364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: