Healthcare Provider Details

I. General information

NPI: 1427655810
Provider Name (Legal Business Name): AN ELEGANT SUFFICIENCY, A PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 W MARCH LN STE 200
STOCKTON CA
95207-8211
US

IV. Provider business mailing address

PO BOX 7067
STOCKTON CA
95267-0067
US

V. Phone/Fax

Practice location:
  • Phone: 209-200-8305
  • Fax: 209-833-7800
Mailing address:
  • Phone: 209-200-8305
  • Fax: 209-833-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHAD RAYMOND CRYDER
Title or Position: PRESIDENT
Credential: PHD
Phone: 408-813-3030