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General NPI Number Information
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NPI Number | 1568849214
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Entity Type | Organization
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Legal Business Name | PACIFIC PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 05/01/2015
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Last Update Date | 05/16/2018
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Provider Practice Location Address
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Address Line | 265 SANTA HELENA STE 214
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City | SOLANA BEACH
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State | CA
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Zip | 92075
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Country | US
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Telephone | 858-480-1661
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Fax | 858-712-3881
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Provider Business Mailing Address
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Address Line | 2351 MANCHESTER AVE
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City | CARDIFF
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State | CA
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Zip | 92007-2009
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Country | US
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Telephone | 858-229-6986
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Fax | 858-712-3881
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Authorized Official
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Title or Position | CIINICAL PSYCHOLOGIST/OWNER
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Name | DR. KIM AJLOUNY FORD
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Credential | PSY.D.
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Telephone | 858-229-6986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY23171
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License Number State | CA
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