1134668932 NPI number — OLFORD-EDDY PSYCHOLOGICAL SERVICES GROUP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134668932 NPI number — OLFORD-EDDY PSYCHOLOGICAL SERVICES GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLFORD-EDDY PSYCHOLOGICAL SERVICES GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BEST BRAIN POSSIBLE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134668932
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
516 W SHAW AVE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93704-2515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-593-2013
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
516 W SHAW AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93704-2515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-593-2013
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/14/2017

Additional Information

Authorized Official

Authorized Official Last Name:
EDDY
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
MARK
Authorized Official Title or Position:
DIRECTOR PRESIDENT
Authorized Official Telephone Number:
559-593-2013

Provider Taxonomy Codes

  • Taxonomy code: 101YP1600X , with the licence number:  NO NUMBER PROVIDED , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NO NUMBER PROVIDED . This is a "MINISTERIAL ORDINATION LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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