Organization Name: | SUPPORTIVE PSYCHOLOGICAL CARE |
NPI Number: | 1366787269 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CYRUS MOAZAM (OWNER) |
Mailing Address: | 9267 Greenback Ln B98 Orangevale |
State: | CA US |
Postal Code: | 956624863 |
Phone Number: | 9165059151 |
Fax Number: | 9169887864 |
NPI Enumeration Date: | 12/03/2012 |
NPI Last Update Date: | 12/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0850X |
License Number: | PSY13748 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Adult Mental Health |
Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |