Provider Demographics
NPI:1063803393
Name:JODIE KNOTT, PH.D., PSYCHOLOGICAL CONSULTING, INC.
Entity type:Organization
Organization Name:JODIE KNOTT, PH.D., PSYCHOLOGICAL CONSULTING, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-490-3428
Mailing Address - Street 1:5212 KATELLA AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-6829
Mailing Address - Country:US
Mailing Address - Phone:714-490-3428
Mailing Address - Fax:562-493-1684
Practice Address - Street 1:5212 KATELLA AVE STE 104
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6829
Practice Address - Country:US
Practice Address - Phone:714-490-3428
Practice Address - Fax:562-493-1684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20647103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty