Provider Demographics
NPI:1184916397
Name:JAMES A PECK PSY D A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:JAMES A PECK PSY D A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-828-7378
Mailing Address - Street 1:2730 WILSHIRE BLVD.
Mailing Address - Street 2:SUITE 650
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4746
Mailing Address - Country:US
Mailing Address - Phone:310-838-7378
Mailing Address - Fax:310-828-7399
Practice Address - Street 1:2730 WILSHIRE BLVD.
Practice Address - Street 2:SUITE 650
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4746
Practice Address - Country:US
Practice Address - Phone:310-838-7378
Practice Address - Fax:310-828-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19076103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty