MEDICARE: COMMUNITY COUNSELING SERVICES CHILD COUNSELOR A PROF CORP DEAN HADDOCK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	PSY 8536	CA
2	103TC2200X	Clinical Child & Adolescent Psychologist	PSY 8536	CA
3	103TF0200X	Forensic Psychologist	PSY 8536	CA
4	103TH0100X	Health Service Psychologist	PSY 8536	CA
5	103TM1800X	Intellectual & Developmental Disabilities Psychologist	PSY 8536	CA
6	103TP0016X	Prescribing (Medical) Psychologist	PSY 8536	CA
7	103TP2701X	Group Psychotherapy Psychologist	PSY 8536	CA
8	106H00000X	Marriage & Family Therapist	MI 13954	CA
9	103TC0700X	Clinical Psychologist	PSY 8536	CA

General Provider Information

NPI Number	:	1346457157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY COUNSELING SERVICES CHILD COUNSELOR A PROF CORP DEAN HADDOCK

Provider Business Mailing Address
First Line	:	PO BOX 82096
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93380-2096
Country	:	US
Telephone Number	:	661-326-8167
Fax Number	:	661-326-8221

Provider Business Practice Location Address
First Line	:	4900 CALIFORNIA AVE
Second Line	:	330-B
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-7024
Country	:	US
Telephone Number	:	661-326-8167
Fax Number	:	661-326-8221

Authorized Official
Title or Position	:	CEO
Name	:	DR. MCCOY DEAN HADDOCK
Credential	:	PSY.D.
Telephone Number	:	661-326-8167

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	04/03/2014

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