Healthcare Provider Details

I. General information

NPI: 1023358926
Provider Name (Legal Business Name): KATHLEEN STROUP NEAL PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN ANNE STROUP PSYD

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24900 HIGHWAY 202 CALIFORNIA CORRECTIONAL INSTITUTION
TEHACHAPI CA
93561
US

IV. Provider business mailing address

PO BOX 534
TEHACHAPI CA
93581-0534
US

V. Phone/Fax

Practice location:
  • Phone: 661-557-5657
  • Fax: 661-823-3362
Mailing address:
  • Phone: 661-822-4402
  • Fax: 661-823-3362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY23511
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: