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General NPI Number Information
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NPI Number | 1487057642
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Entity Type | Organization
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Legal Business Name | THE PSYCHOLOGICAL GROUP
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 302 WASHINGTON ST STE 1501938
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City | SAN DIEGO
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State | CA
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Zip | 92103-2110
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Country | US
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Telephone | 800-790-0890
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Fax | 888-742-9360
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Provider Business Mailing Address
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Address Line | 302 WASHINGTON ST STE 1501938
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City | SAN DIEGO
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State | CA
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Zip | 92103-2110
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Country | US
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Telephone | 800-790-0890
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Fax | 888-742-9360
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER CHRISTOPHER COOPER
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Credential | PHD
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Telephone | 800-790-0890
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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 | PSY23144
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License Number State | CA
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