Provider Demographics
NPI:1235350570
Name:A CLINICAL PSYCHOLOGY PRACTICE INC
Entity Type:Organization
Organization Name:A CLINICAL PSYCHOLOGY PRACTICE INC
Other - Org Name:SABINE U GAEDT PHD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SABINE
Authorized Official - Middle Name:K
Authorized Official - Last Name:GAEDT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:760-340-2476
Mailing Address - Street 1:PO BOX 1108
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-340-2476
Mailing Address - Fax:760-340-2476
Practice Address - Street 1:74040 HIGHWAY 111
Practice Address - Street 2:STEJ4
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4134
Practice Address - Country:US
Practice Address - Phone:760-340-2476
Practice Address - Fax:760-340-2476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13454103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ03046ZMedicare ID - Type Unspecified