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General NPI Number Information
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NPI Number | 1770355398
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL EVALUATION CENTER OF NORTH AMERICA (PECNA)
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Dates
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Enumeration Date | 10/26/2023
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Last Update Date | 10/26/2023
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Provider Practice Location Address
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Address Line | 1003 BISHOP STREET SUITE 2700 PMB #368
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City | HONOLULU
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State | HI
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Zip | 96813-9262
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Country | US
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Telephone | 949-949-1001
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Fax |
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Provider Business Mailing Address
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Address Line | 34821 CAMINO CAPISTRANO
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City | CAPISTRANO BEACH
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State | CA
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Zip | 92624-1722
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Country | US
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Telephone | 949-949-0002
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | IRADA WATTANAVITUKUL
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Credential | PH.D., LMHC
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Telephone | 949-949-0002
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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 |
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License Number State |
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