1477118131 NPI number — California Forensic Psychology, PC Dana R Anderson PSYD

Table of content: Dana R Anderson PSYD (NPI 1477118131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477118131 NPI number — California Forensic Psychology, PC Dana R Anderson PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
California Forensic Psychology, PC
Provider Last Name:
Anderson
Provider First Name:
Dana
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

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:
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Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477118131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4484 Crimsonwood Drive
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDDING
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
(530) 232-8150
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2135 Pine Street
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
(530) 232-8150
Provider Business Practice Location Address Fax Number:
(530) 215-3676
Provider Enumeration Date:
05/07/2019

Additional Information

Authorized Official

Authorized Official Last Name:
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Provider Taxonomy Codes

  • Taxonomy code: 103TF0200X , with the licence number:  33617 , 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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