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General NPI Number Information
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NPI Number | 1861557571
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Entity Type | Individual
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Provider Name | JOSEPH EDWARD HOLIFIELD PH.D.
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Gender | Male
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 3220 S HIGUERA ST SUITE 306
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-6987
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Country | US
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Telephone | 805-305-4229
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6760
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City | LOS OSOS
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State | CA
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Zip | 93412-6760
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Country | US
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Telephone | 805-305-4229
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Fax |
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY 19617
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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 | LEP 2544
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071006466
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License Number State | IL
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