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General NPI Number Information
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NPI Number | 1386172872
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Entity Type | Individual
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Provider Name | JOSEPH CULLEY HARRELSON
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Gender | Male
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Dates
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Enumeration Date | 05/26/2017
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Last Update Date | 06/15/2017
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Provider Practice Location Address
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Address Line | 103 S FOREST RD
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City | SONORA
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State | CA
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Zip | 95370-4895
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Country | US
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Telephone | 209-533-1699
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Fax |
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Provider Business Mailing Address
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Address Line | 77 LINOBERG ST
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City | SONORA
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State | CA
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Zip | 95370-4607
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Country | US
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Telephone | 209-770-0003
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSB94023382
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License Number State | CA
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