=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285134361
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RANGAN COUNSELING AND PSYCHOLOGY, A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2018
-----------------------------------------------------
Last Update Date | 02/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 825 SAN ANTONIO RD
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94303-4635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-434-3076
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 825 SAN ANTONIO RD
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94303-4635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-434-3076
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RACHNA RANGAN
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 650-434-3076
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 29636
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------