Provider Demographics
NPI:1427655810
Name:AN ELEGANT SUFFICIENCY, A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:AN ELEGANT SUFFICIENCY, A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:CRYDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:408-813-3030
Mailing Address - Street 1:PO BOX 7067
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0067
Mailing Address - Country:US
Mailing Address - Phone:209-200-8305
Mailing Address - Fax:209-833-7800
Practice Address - Street 1:2431 W MARCH LN STE 200
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8211
Practice Address - Country:US
Practice Address - Phone:209-200-8305
Practice Address - Fax:209-833-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA439632Medicaid