Healthcare Provider Details

I. General information

NPI: 1447874664
Provider Name (Legal Business Name): AP PSYCHOLOGY SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MARINA DR
SEAL BEACH CA
90740-6023
US

IV. Provider business mailing address

200 MARINA DR
SEAL BEACH CA
90740-6023
US

V. Phone/Fax

Practice location:
  • Phone: 562-431-9293
  • Fax: 562-685-0413
Mailing address:
  • Phone: 562-431-9293
  • Fax: 562-685-0413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: IVY DIMAS
Title or Position: BILLING SPECIALIST
Credential:
Phone: 224-422-9760