Provider Demographics
NPI:1437398468
Name:JAMES A. REAVIS, PSY.D. A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:JAMES A. REAVIS, PSY.D. A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:REAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:619-234-7970
Mailing Address - Street 1:964 5TH AVE # 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-6102
Mailing Address - Country:US
Mailing Address - Phone:619-234-7970
Mailing Address - Fax:619-699-5945
Practice Address - Street 1:964 5TH AVE # 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-6102
Practice Address - Country:US
Practice Address - Phone:619-234-7970
Practice Address - Fax:619-699-5945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-14
Last Update Date:2009-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17404251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health