Provider Demographics
NPI:1477090488
Name:CENTER FOR NEUROPSYCHOLOGY, A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:CENTER FOR NEUROPSYCHOLOGY, A PSYCHOLOGICAL CORPORATION
Other - Org Name:CENTER FOR NEUROPSYCHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRABRECK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:530-710-1070
Mailing Address - Street 1:2628 VICTOR AVE STE B
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1454
Mailing Address - Country:US
Mailing Address - Phone:530-710-1070
Mailing Address - Fax:
Practice Address - Street 1:2628 VICTOR AVE STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1454
Practice Address - Country:US
Practice Address - Phone:530-710-1070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-28
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26823103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty