Basic Information
| Provider Information | |||||||||
| NPI: | 1982607784 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DANIEL D. SHIRBROUN, PHD, INC, PSYCHOLOGIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 54045 RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | YUCCA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922848311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603652588 | ||||||||
| FaxNumber: | 7603697167 | ||||||||
| Practice Location | |||||||||
| Address1: | 7293 DUMOSA AVE | ||||||||
| Address2: | STE 8 | ||||||||
| City: | YUCCA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922843700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603697166 | ||||||||
| FaxNumber: | 7603697167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SHIRBROUN | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | DEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 7603697166 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY4161 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.