Provider Demographics
NPI:1992318893
Name:PSYCHDOC INC, A PROFESSIONAL PSYCHOLOGY CORPORATION
Entity type:Organization
Organization Name:PSYCHDOC INC, A PROFESSIONAL PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:877-815-8845
Mailing Address - Street 1:2100 PALOMAR AIRPORT RD STE 214-16
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-4402
Mailing Address - Country:US
Mailing Address - Phone:877-815-8845
Mailing Address - Fax:833-282-1430
Practice Address - Street 1:2650 CAMINO DEL RIO N STE 108
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1631
Practice Address - Country:US
Practice Address - Phone:877-815-8845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty