1851711881 NPI number — JOHN K. RUSSELL, PH.D. A PSYCHOLOGICAL CORPORATION

Table of content: (NPI 1851711881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851711881 NPI number — JOHN K. RUSSELL, PH.D. A PSYCHOLOGICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN K. RUSSELL, PH.D. A PSYCHOLOGICAL CORPORATION
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:
1851711881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1945 PALO VERDE AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90815-3443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-799-3333
Provider Business Mailing Address Fax Number:
562-799-3355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1945 PALO VERDE AVENUE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90815-3445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-799-3333
Provider Business Practice Location Address Fax Number:
562-799-3355
Provider Enumeration Date:
04/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
RUSSELL
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
KENNETH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
562-799-3333

Provider Taxonomy Codes

  • Taxonomy code: 103TA0400X , with the licence number:  PSY4430 , 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)





Copyright © 2007-2025 www.npivalidator.com