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NPI Code Detail

MEDICARE: STEPHANIE KNATZ PECK PHD PSYCHOLOGICAL SERVICES INC

MEDICARE: STEPHANIE KNATZ PECK PHD PSYCHOLOGICAL SERVICES INC
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1881307544
Entity Type Code : Organization
Provider Name (Legal Business Name) : STEPHANIE KNATZ PECK PHD PSYCHOLOGICAL SERVICES INC
Provider Business Mailing Address
First Line : 1010 TURQUOISE ST STE 303
Second Line :
City : SAN DIEGO
State : CA
Zip : 92109-1268
Country : US
Telephone Number : 858-255-4095
Fax Number : 619-566-3845
Provider Business Practice Location Address
First Line : 1010 TURQUOISE ST STE 303
Second Line :
City : SAN DIEGO
State : CA
Zip : 92109-1268
Country : US
Telephone Number : 858-255-4095
Fax Number : 619-566-3845
Authorized Official
Title or Position : OWNER/DIRECTOR
Name : STEPHANIE KNATZ PECK
Credential : PHD
Telephone Number : 858-255-4095
Provider Enumeration Date : 12/27/2022
Last Update Date : 11/15/2023

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