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General NPI Number Information
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NPI Number | 1881556967
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Entity Type | Organization
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Legal Business Name | PSYCHED TO GROW PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 11/26/2025
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 3600 SISK RD STE 5A
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City | MODESTO
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State | CA
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Zip | 95356-0540
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Country | US
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Telephone | 209-202-3450
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 SISK RD STE 5A
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City | MODESTO
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State | CA
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Zip | 95356-0540
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Country | US
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Telephone | 209-202-3540
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JASMIN LOZA
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Credential | LEP
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Telephone | 209-356-5878
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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 |
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License Number State |
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