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General NPI Number Information
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NPI Number | 1730386269
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Entity Type | Individual
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Provider Name | JOHN THOMAS HAVEY PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 09/16/2010
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Provider Practice Location Address
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Address Line | 9093 ELK GROVE BLVD # 206
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City | ELK GROVE
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State | CA
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Zip | 95624-2047
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Country | US
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Telephone | 808-284-7770
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Fax | 888-371-4292
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Provider Business Mailing Address
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Address Line | 4935 61ST ST
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City | SACRAMENTO
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State | CA
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Zip | 95820-5703
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Country | US
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Telephone | 808-284-7770
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Fax | 888-371-4292
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 21388
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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 | 1124
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License Number State | HI
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