1548582364 NPI number — APPLIED PSYCHOLOGICAL HEALTH INC

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 1548582364 NPI number — APPLIED PSYCHOLOGICAL HEALTH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APPLIED PSYCHOLOGICAL HEALTH INC
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:
Provider Other Organization Name Type Code:
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:
1548582364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6816 CIBOLA RD STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92120-1707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-770-7192
Provider Business Mailing Address Fax Number:
619-393-1770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1224 10TH ST STE 201A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORONADO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92118-3420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-770-7192
Provider Business Practice Location Address Fax Number:
619-393-1770
Provider Enumeration Date:
02/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KABBAN-MOSES
Authorized Official First Name:
MAHA
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
619-770-7192

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  PSY21837 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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