Provider Demographics
NPI:1649639774
Name:MCCRAY PSYCHOLOGICAL SERVICES, INC.
Entity type:Organization
Organization Name:MCCRAY PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:530-318-2131
Mailing Address - Street 1:PO BOX 7525
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96158-0525
Mailing Address - Country:US
Mailing Address - Phone:530-318-2131
Mailing Address - Fax:866-899-6977
Practice Address - Street 1:1620 N CARPENTER RD STE D59
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-1148
Practice Address - Country:US
Practice Address - Phone:530-318-2131
Practice Address - Fax:866-899-6977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17068252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency