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General NPI Number Information
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NPI Number | 1528542149
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Entity Type | Organization
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Legal Business Name | CENTER FOR POST TRAUMATIC GROWTH
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Dates
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Enumeration Date | 09/19/2018
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 11344 COLOMA RD STE 347
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City | GOLD RIVER
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State | CA
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Zip | 95670-4460
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Country | US
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Telephone | 916-743-7673
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Fax |
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Provider Business Mailing Address
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Address Line | 5521 GRASSY RUN CT
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City | PLACERVILLE
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State | CA
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Zip | 95667-9739
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Country | US
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Telephone | 916-743-7673
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. MELINDA JANE KEENAN
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Credential | LIC. PSYCHOLOGIST
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Telephone | 720-743-7673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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