Provider Demographics
NPI:1598893125
Name:SCRIPPS PSYCHOLOGICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:SCRIPPS PSYCHOLOGICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:916-446-3111
Mailing Address - Street 1:1012 19TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-4102
Mailing Address - Country:US
Mailing Address - Phone:916-446-3111
Mailing Address - Fax:916-446-3131
Practice Address - Street 1:1012 19TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-4102
Practice Address - Country:US
Practice Address - Phone:916-446-3111
Practice Address - Fax:916-446-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6474103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty