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General NPI Number Information
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NPI Number | 1245686153
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Entity Type | Organization
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Legal Business Name | CENTRAL CALIFORNIA PSYCHOLOGICAL SERVICES, INC
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 01/03/2017
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Provider Practice Location Address
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Address Line | 3120 W MAIN ST STE B
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City | VISALIA
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State | CA
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Zip | 93291-5764
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Country | US
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Telephone | 559-423-0723
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Fax |
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Provider Business Mailing Address
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Address Line | 3120 W MAIN ST STE B
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City | VISALIA
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State | CA
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Zip | 93291-5764
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Country | US
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Telephone | 559-423-0723
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELISABETH KING
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Credential | PSY. D.
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Telephone | 559-259-5886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PSY20259
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License Number State | CA
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