Provider Demographics
NPI:1043860661
Name:IPSYCHOLOGICAL PC
Entity Type:Organization
Organization Name:IPSYCHOLOGICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIJAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MEEKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-975-4358
Mailing Address - Street 1:1298 ANTELOPE CREEK DR UNIT 422
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-2282
Mailing Address - Country:US
Mailing Address - Phone:916-975-4358
Mailing Address - Fax:
Practice Address - Street 1:6518 LONETREE BLVD STE 152
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5874
Practice Address - Country:US
Practice Address - Phone:916-975-4358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty