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General NPI Number Information
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NPI Number | 1124449400
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Entity Type | Organization
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Legal Business Name | UNIVERSAL PSYCHOLOGICAL SERVICES INC
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Dates
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Enumeration Date | 01/03/2014
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Last Update Date | 04/30/2020
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Provider Practice Location Address
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Address Line | 20241 SW BIRCH ST SUITE 202
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-1782
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Country | US
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Telephone | 949-514-5438
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Fax |
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Provider Business Mailing Address
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Address Line | 20241 SW BIRCH ST SUITE 202
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-1782
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Country | US
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Telephone | 949-955-9100
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Fax |
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Authorized Official
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Title or Position | CEO-CLINICAL PSYCHOLOGIST
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Name | DR. NORMA YACOUB
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Credential | PSYD
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Telephone | 949-955-9100
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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 | PSY24329
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License Number State | CA
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