Provider Demographics
NPI:1669612404
Name:VALLEY PSYCHOLOGICAL GROUP
Entity type:Organization
Organization Name:VALLEY PSYCHOLOGICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LONGWITH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:661-327-4252
Mailing Address - Street 1:1800 WESTWIND DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3055
Mailing Address - Country:US
Mailing Address - Phone:661-327-4252
Mailing Address - Fax:661-327-3409
Practice Address - Street 1:1800 WESTWIND DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3055
Practice Address - Country:US
Practice Address - Phone:661-327-4252
Practice Address - Fax:661-327-3409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC21849106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty