Provider Demographics
NPI:1326516899
Name:SOCIAL STAMINA BEHAVIOR CONSULT SERVICES, INC.
Entity Type:Organization
Organization Name:SOCIAL STAMINA BEHAVIOR CONSULT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED EDUCATIONAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON-LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LEP
Authorized Official - Phone:661-717-5146
Mailing Address - Street 1:9118 ROCKHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-5058
Mailing Address - Country:US
Mailing Address - Phone:661-717-5146
Mailing Address - Fax:
Practice Address - Street 1:7400 DISTRICT BLVD STE C
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-4818
Practice Address - Country:US
Practice Address - Phone:661-282-7395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty