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General NPI Number Information
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NPI Number | 1073804308
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Entity Type | Organization
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Legal Business Name | AMERICAN COLLEGE OF BEHAVIORAL MEDICINE
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Dates
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Enumeration Date | 04/20/2011
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 4637 CHABOT DR STE 102
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City | PLEASANTON
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State | CA
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Zip | 94588-2805
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Country | US
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Telephone | 925-416-1400
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Fax | 925-416-1410
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Provider Business Mailing Address
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Address Line | 4637 CHABOT DR STE 102
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City | PLEASANTON
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State | CA
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Zip | 94588-2805
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Country | US
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Telephone | 925-416-1400
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Fax | 925-416-1410
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALI HASHEMIAN
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Credential | PH.D
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Telephone | 925-416-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 17785
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License Number State | CA
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