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General NPI Number Information
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NPI Number | 1063803393
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Entity Type | Organization
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Legal Business Name | JODIE KNOTT, PH.D., PSYCHOLOGICAL CONSULTING, INC.
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 5212 KATELLA AVE STE 104
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-6829
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Country | US
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Telephone | 714-490-3428
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Fax | 562-493-1684
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Provider Business Mailing Address
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Address Line | 5212 KATELLA AVE STE 104
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-6829
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Country | US
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Telephone | 714-490-3428
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Fax | 562-493-1684
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST/PRESIDENT
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Name | JODIE KNOTT
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Credential | PH.D.
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Telephone | 714-490-3428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSY20647
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License Number State | CA
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