=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750006052
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAVARRO PSYCHOLOGICAL & COUNSELING SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2022
-----------------------------------------------------
Last Update Date | 10/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 802 MAGNOLIA AVENUE SUITE 107
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-708-1322
-----------------------------------------------------
Fax | 951-266-6482
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 802 MAGNOLIA AVENUE SUITE 107
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-708-1322
-----------------------------------------------------
Fax | 951-266-6482
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | MELVIN NAVARRO
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 951-708-1322
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------