Provider Demographics
NPI:1679665939
Name:PACIFIC RESOURCES PSYCHOLOGICAL GROUP
Entity Type:Organization
Organization Name:PACIFIC RESOURCES PSYCHOLOGICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:562-988-1000
Mailing Address - Street 1:4201 LONG BEACH BLVD
Mailing Address - Street 2:STE.230
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2007
Mailing Address - Country:US
Mailing Address - Phone:562-988-1000
Mailing Address - Fax:562-426-5211
Practice Address - Street 1:4201 LONG BEACH BLVD
Practice Address - Street 2:STE.230
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2007
Practice Address - Country:US
Practice Address - Phone:562-988-1000
Practice Address - Fax:562-426-5211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty