Provider Demographics
NPI:1134668932
Name:OLFORD-EDDY PSYCHOLOGICAL SERVICES GROUP
Entity Type:Organization
Organization Name:OLFORD-EDDY PSYCHOLOGICAL SERVICES GROUP
Other - Org Name:BEST BRAIN POSSIBLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:EDDY
Authorized Official - Suffix:
Authorized Official - Credentials:REV
Authorized Official - Phone:559-593-2013
Mailing Address - Street 1:516 W SHAW AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-2515
Mailing Address - Country:US
Mailing Address - Phone:559-593-2013
Mailing Address - Fax:
Practice Address - Street 1:516 W SHAW AVE STE 200
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2515
Practice Address - Country:US
Practice Address - Phone:559-593-2013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLFORD-EDDY PSCHOLOGICAL SERVICES GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILNO NUMBER PROVIDED101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILNO NUMBER PROVIDEDOtherMINISTERIAL ORDINATION LICENSE