Basic Information
| Provider Information | |||||||||
| NPI: | 1457612004 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TULARE COUNTY OFFICE OF EDUCATION BEHAVIORAL HEALTH SERVICES | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | TULARE COUNTY OFFICE OF EDUCATION | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1830 S CENTRAL ST | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932774418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597302969 | ||||||||
| FaxNumber: | 5597302991 | ||||||||
| Practice Location | |||||||||
| Address1: | 1830 S CENTRAL ST | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932774418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597302969 | ||||||||
| FaxNumber: | 5597302991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2012 | ||||||||
| LastUpdateDate: | 03/01/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | NEWELL | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR, BEHAVIORAL HEALTHSERVICES | ||||||||
| AuthorizedOfficialTelephone: | 5597470115 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PSY.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251300000X | PSY22377 | CA | Y | Agencies | Local Education Agency (LEA) |
No ID Information.