=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023625738
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACRO CONSULTANCY SERVICES A PSYCHOLOGICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2020
-----------------------------------------------------
Last Update Date | 09/26/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 E FOOTHILL BLVD STE 406
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91107-7122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-538-5531
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1107 FAIR OAKS AVE # 422
-----------------------------------------------------
City | SOUTH PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91030-3311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | CARMEN PAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-538-5531
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------