=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225464407
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INFLUX PSYCHOLOGICAL SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2013
-----------------------------------------------------
Last Update Date | 09/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3636 4TH AVE STE 302
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92103-4280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-800-8255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3636 4TH AVE 302
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92103-4280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-800-8255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MEGHAN N BROWN
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 619-800-8255
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY 25587
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------