=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043860661
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IPSYCHOLOGICAL PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2019
-----------------------------------------------------
Last Update Date | 01/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6518 LONETREE BLVD STE 162
-----------------------------------------------------
City | ROCKLIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95765-5874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-975-4358
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6904 MAIN AVE
-----------------------------------------------------
City | ORANGEVALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95662-3621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-975-4358
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ELIJAH S MEEKER
-----------------------------------------------------
Credential | PSY.D
-----------------------------------------------------
Telephone | 916-975-4358
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------