1043607450 NPI number — PSYCHOLOGICAL SERVICES GROUP

Table of content: DILLETTE REMY ANDRES MERIANG (NPI 1912780339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043607450 NPI number — PSYCHOLOGICAL SERVICES GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
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:
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:
1043607450
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1868 CLAYTON RD
Provider Second Line Business Mailing Address:
SUITE 126
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94520-2547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-609-8448
Provider Business Mailing Address Fax Number:
925-609-7222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1868 CLAYTON RD
Provider Second Line Business Practice Location Address:
SUITE 126
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94520-2547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-609-8448
Provider Business Practice Location Address Fax Number:
925-609-7222
Provider Enumeration Date:
04/23/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DANSIE
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
925-609-8448

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  LMFT 30254 , 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)