Provider Demographics
NPI:1174685911
Name:STROUP, EMEL D (PSYD, ABPP, ACT)
Entity Type:Individual
Prefix:DR
First Name:EMEL
Middle Name:D
Last Name:STROUP
Suffix:
Gender:F
Credentials:PSYD, ABPP, ACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 97, BOX 0002
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09827
Mailing Address - Country:US
Mailing Address - Phone:90536-645-9375
Mailing Address - Fax:
Practice Address - Street 1:2108 N ST STE 4505
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5712
Practice Address - Country:US
Practice Address - Phone:858-252-2608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27114103TB0200X, 103TC0700X, 103T00000X
OK1032103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103T00000XBehavioral Health & Social Service ProvidersPsychologist