=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063531192
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PSYCHOLOGICAL SERVICES FOR FAMILIES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 E ESPLANADE DR SUITE 860
-----------------------------------------------------
City | OXNARD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93036-2110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-278-1997
-----------------------------------------------------
Fax | 805-278-2295
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1133
-----------------------------------------------------
City | OAK VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93022-1133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-278-1997
-----------------------------------------------------
Fax | 805-278-2295
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | DR. JOELLEN STEVENS, PH.D.
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 805-278-1997
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY12171
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------