Provider Demographics
NPI:1497200406
Name:SAN DIEGO CENTER FOR NEUROFEEDBACK
Entity Type:Organization
Organization Name:SAN DIEGO CENTER FOR NEUROFEEDBACK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-436-4263
Mailing Address - Street 1:12064 WOODSIDE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-2952
Mailing Address - Country:US
Mailing Address - Phone:619-436-4263
Mailing Address - Fax:
Practice Address - Street 1:12064 WOODSIDE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKESIDE
Practice Address - State:CA
Practice Address - Zip Code:92040-2952
Practice Address - Country:US
Practice Address - Phone:619-436-4263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty