=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568764306
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRI-VALLEY BEHAVIORAL HEALTH RESOURCES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2010
-----------------------------------------------------
Last Update Date | 05/14/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22306 CYPRESS PLACE
-----------------------------------------------------
City | SANTA CLARITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91390-4088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-388-8212
-----------------------------------------------------
Fax | 661-244-0015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22306 CYPRESS PL
-----------------------------------------------------
City | SANTA CLARITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91390-4088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-388-8212
-----------------------------------------------------
Fax | 661-244-0015
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. JOYCE W ROBERSON
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 661-388-8212
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TB0200X
-----------------------------------------------------
Taxonomy Name | Cognitive & Behavioral Psychologist
-----------------------------------------------------
License Number | 23711
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------