Provider Demographics
NPI:1891953402
Name:COUNSELING & PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:COUNSELING & PSYCHOLOGICAL SERVICES
Other - Org Name:UNIVERSITY OF CALIFORNIA DAVIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RODOLFA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:530-752-0871
Mailing Address - Street 1:1 SHIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-5270
Mailing Address - Country:US
Mailing Address - Phone:530-752-0871
Mailing Address - Fax:530-752-9923
Practice Address - Street 1:219 NORTH HALL
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616
Practice Address - Country:US
Practice Address - Phone:530-752-0871
Practice Address - Fax:530-752-9923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM011999106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty