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General NPI Number Information
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NPI Number | 1114411618
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Entity Type | Organization
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Legal Business Name | FOSS PSYCHOLOGICAL SERVICES INC.
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Dates
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Enumeration Date | 06/18/2018
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Last Update Date | 06/18/2018
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Provider Practice Location Address
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Address Line | 448 S MARENGO AVE
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City | PASADENA
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State | CA
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Zip | 91101-3113
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Country | US
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Telephone | 626-840-5740
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Fax |
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Provider Business Mailing Address
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Address Line | 1108 W AMERIGE AVE
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City | FULLERTON
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State | CA
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Zip | 92833-2708
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESSICA FOSS
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Credential | PHD
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Telephone | 626-840-5740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT83193
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY28674
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License Number State | CA
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