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General NPI Number Information
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NPI Number | 1427085349
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Entity Type | Organization
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Legal Business Name | SEQUOIA PSYCHOTHERAPY CENTER, INC
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 03/29/2019
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Provider Practice Location Address
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Address Line | 1960 N. GATEWAY BLVD
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City | FRESNO
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State | CA
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Zip | 93727
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Country | US
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Telephone | 559-266-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 1960 N. GATEWAY BLVD
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City | FRESNO
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State | CA
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Zip | 93727
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Country | US
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Telephone | 559-266-5200
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE CLINICAL DIRECTOR
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Name | DR. MARK DAVID POPPER
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Credential | PH.D.
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Telephone | 559-266-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | PSY 13574
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License Number State | CA
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