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General NPI Number Information
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NPI Number | 1235350570
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Entity Type | Organization
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Legal Business Name | A CLINICAL PSYCHOLOGY PRACTICE INC
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 09/28/2007
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Provider Practice Location Address
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Address Line | 74040 HIGHWAY 111 STEJ4
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City | PALM DESERT
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State | CA
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Zip | 92260-4134
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Country | US
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Telephone | 760-340-2476
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Fax | 760-340-2476
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Provider Business Mailing Address
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Address Line | PO BOX 1108
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270
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Country | US
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Telephone | 760-340-2476
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Fax | 760-340-2476
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SABINE K GAEDT
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Credential | PHD
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Telephone | 760-340-2476
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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 | PSY13454
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License Number State | CA
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