Provider Demographics
NPI:1275966988
Name:EKERETTE J ESSIEN, PHD
Entity Type:Organization
Organization Name:EKERETTE J ESSIEN, PHD
Other - Org Name:CALIFORNIA STRESS CONTROL MGMT CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EKERETTE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ESSIEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:951-660-3050
Mailing Address - Street 1:16795 CATALONIA DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-8705
Mailing Address - Country:US
Mailing Address - Phone:951-660-3050
Mailing Address - Fax:888-235-1709
Practice Address - Street 1:5206 BENITO ST
Practice Address - Street 2:STE 106
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2852
Practice Address - Country:US
Practice Address - Phone:951-660-3050
Practice Address - Fax:888-235-1709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17740103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY177400Medicaid
CABN267AMedicare PIN
CAPSY177400Medicaid