Healthcare Provider Details

I. General information

NPI: 1528451663
Provider Name (Legal Business Name): ROGER L. GIRION,PH.D., P.C,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2015
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 W AVENUE J
LANCASTER CA
93534-2814
US

IV. Provider business mailing address

1652 W AVENUE J
LANCASTER CA
93534-2814
US

V. Phone/Fax

Practice location:
  • Phone: 661-249-6720
  • Fax: 661-249-6859
Mailing address:
  • Phone: 661-249-6720
  • Fax: 661-249-6859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS19553
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT52935
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY24704
License Number StateCA

VIII. Authorized Official

Name: NICOLE SEGROVES
Title or Position: OFFICE MANAGER
Credential:
Phone: 661-249-6720