Provider Demographics
NPI:1720141674
Name:ALLIANT EDUCATIONAL FOUNDATION
Entity Type:Organization
Organization Name:ALLIANT EDUCATIONAL FOUNDATION
Other - Org Name:PSYCHOLOGICAL SERVICES CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HASSE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD-PAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:510-628-9065
Mailing Address - Street 1:1440 BROADWAY STE 610
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2026
Mailing Address - Country:US
Mailing Address - Phone:510-628-9065
Mailing Address - Fax:510-628-9068
Practice Address - Street 1:1440 BROADWAY STE 610
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2026
Practice Address - Country:US
Practice Address - Phone:510-628-9065
Practice Address - Fax:510-628-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000233251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health