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General NPI Number Information
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NPI Number | 1326178310
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Entity Type | Organization
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Legal Business Name | SHIODE PSYCHOTHERAPY, INC.
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 06/19/2009
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Provider Practice Location Address
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Address Line | 501 S. RANCHO DR. STE I-64
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City | LAS VEGAS
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State | NV
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Zip | 89106
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Country | US
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Telephone | 702-384-4110
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Fax | 702-384-7954
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Provider Business Mailing Address
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Address Line | 501 S. RANCHO DR. STE I-64
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City | LAS VEGAS
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State | NV
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Zip | 89106
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Country | US
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Telephone | 702-384-4110
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Fax | 702-384-7954
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL T SHIODE
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Credential | PH.D.
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Telephone | 702-384-4110
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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 | PY0244
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License Number State | NV
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