=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407312481
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL GIROUARD, PHD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2019
-----------------------------------------------------
Last Update Date | 02/14/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 598 W GRANGEVILLE BLVD STE 103
-----------------------------------------------------
City | HANFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93230-2833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-585-1898
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1890 W RIO HONDO WAY
-----------------------------------------------------
City | HANFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93230-1116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-836-9903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. MICHAEL GIROUARD
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 559-585-1898
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------