Healthcare Provider Details

I. General information

NPI: 1508197195
Provider Name (Legal Business Name): JO ELLEN ELIZABETH ENG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1187 COAST VILLAGE RD SUITE 10 B
SANTA BARBARA CA
93108-2737
US

IV. Provider business mailing address

1187 COAST VILLAGE RD SUITE 10 B
SANTA BARBARA CA
93108-2737
US

V. Phone/Fax

Practice location:
  • Phone: 805-403-8541
  • Fax:
Mailing address:
  • Phone: 805-403-8541
  • Fax: 805-962-6196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY21941
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY21941
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY21941
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY21941
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY21941
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: