Provider Demographics
NPI:1780859041
Name:ECHOLS, MYRNA VEDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MYRNA
Middle Name:VEDA
Last Name:ECHOLS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2985 LINDEN LN
Mailing Address - Street 2:APT J
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-4337
Mailing Address - Country:US
Mailing Address - Phone:916-514-0166
Mailing Address - Fax:916-514-0166
Practice Address - Street 1:2985 LINDEN LN
Practice Address - Street 2:APT J
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-4337
Practice Address - Country:US
Practice Address - Phone:916-514-0166
Practice Address - Fax:916-514-0166
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 7341103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PU0073410OtherMEDICAL
CA00PL73410Medicare UPIN