Provider Demographics
NPI:1558396218
Name:PARK, JAMES J (PHD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:J
Last Name:PARK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:6 GOVERNORS LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-5590
Mailing Address - Country:US
Mailing Address - Phone:530-894-7275
Mailing Address - Fax:530-894-0929
Practice Address - Street 1:6 GOVERNORS LN
Practice Address - Street 2:SUITE B
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-5590
Practice Address - Country:US
Practice Address - Phone:530-894-7275
Practice Address - Fax:530-894-0929
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY12723103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL127230Medicare ID - Type Unspecified