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General NPI Number Information
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NPI Number | 1669603320
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Entity Type | Organization
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Legal Business Name | JOHN E. ROE, PH.D., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 07/29/2009
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 4120 CAMERON PARK DR SUITE 301
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City | CAMERON PARK
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State | CA
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Zip | 95682-7212
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Country | US
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Telephone | 530-676-4555
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Fax | 530-676-4555
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Provider Business Mailing Address
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Address Line | 4120 CAMERON PARK DR SUITE 301
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City | CAMERON PARK
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State | CA
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Zip | 95682-7212
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN E. ROE
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Credential | PH.D.
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Telephone | 530-676-4555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT 6551
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY 5769
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License Number State | CA
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