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General NPI Number Information
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NPI Number | 1750820767
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Entity Type | Organization
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Legal Business Name | STEWART INTEGRATIVE PSYCHOLOGICAL SERVICES, INC
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Dates
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Enumeration Date | 02/23/2017
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Last Update Date | 02/23/2017
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Provider Practice Location Address
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Address Line | 6235 N FRESNO ST STE 101
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City | FRESNO
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State | CA
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Zip | 93710-5269
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Country | US
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Telephone | 559-213-0025
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Fax | 877-484-1076
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Provider Business Mailing Address
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Address Line | 6235 N FRESNO ST STE 101
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City | FRESNO
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State | CA
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Zip | 93710-5269
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Country | US
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Telephone | 559-213-0025
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Fax | 877-484-1076
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Authorized Official
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Title or Position | BILLER
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Name | JAYLENE BOOTH
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Credential |
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Telephone | 559-797-6055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 21346
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License Number State | CA
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