Provider Demographics
NPI:1972182970
Name:THE PACIFIC RESILIENCY CENTER FOR PSYCHOLOGY, WELLNESS, AND THE ARTS
Entity Type:Organization
Organization Name:THE PACIFIC RESILIENCY CENTER FOR PSYCHOLOGY, WELLNESS, AND THE ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:209-910-3383
Mailing Address - Street 1:3134 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-3640
Mailing Address - Country:US
Mailing Address - Phone:209-910-3383
Mailing Address - Fax:866-256-0351
Practice Address - Street 1:3134 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-3640
Practice Address - Country:US
Practice Address - Phone:209-910-3383
Practice Address - Fax:866-256-0351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty