Healthcare Provider Details

I. General information

NPI: 1831478866
Provider Name (Legal Business Name): JEFFREY AUTHOR POUNCEY PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GEORGIA ST 304
VALLEJO CA
94590-5946
US

IV. Provider business mailing address

301 GEORGIA ST 304
VALLEJO CA
94590-5946
US

V. Phone/Fax

Practice location:
  • Phone: 707-373-0392
  • Fax:
Mailing address:
  • Phone: 707-373-0392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: