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General NPI Number Information
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NPI Number | 1598893125
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Entity Type | Organization
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Legal Business Name | SCRIPPS PSYCHOLOGICAL ASSOCIATES, INC
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1012 19TH ST
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City | SACRAMENTO
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State | CA
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Zip | 95814-4102
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Country | US
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Telephone | 916-446-3111
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Fax | 916-446-3131
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Provider Business Mailing Address
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Address Line | 1012 19TH ST
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City | SACRAMENTO
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State | CA
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Zip | 95814-4102
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Country | US
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Telephone | 916-446-3111
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Fax | 916-446-3131
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SIDNEY KEITH NELSON
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Credential | PH.D.
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Telephone | 916-446-3111
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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 | PSY6474
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License Number State | CA
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