Provider Demographics
NPI:1104659408
Name:ANAHEIM ELEMENTARY SCHOOL DISTRICT
Entity type:Organization
Organization Name:ANAHEIM ELEMENTARY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL PROGRAM PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MAI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:EDUCATION SPECIALIST
Authorized Official - Phone:714-620-4361
Mailing Address - Street 1:1001 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5749
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 S HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5531
Practice Address - Country:US
Practice Address - Phone:714-517-8914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty