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General NPI Number Information
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NPI Number | 1649639774
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Entity Type | Organization
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Legal Business Name | MCCRAY PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 1620 N CARPENTER RD STE D59
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City | MODESTO
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State | CA
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Zip | 95351-1148
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Country | US
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Telephone | 530-318-2131
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Fax | 866-899-6977
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Provider Business Mailing Address
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Address Line | PO BOX 7525
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96158-0525
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Country | US
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Telephone | 530-318-2131
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Fax | 866-899-6977
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES MCCRAY
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Credential | PSY.D.
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Telephone | 530-318-2131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | PSY 17068
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License Number State | CA
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