Provider Demographics
NPI:1801059597
Name:PSYCHOLOGICAL ASSESSMENT SERVICES
Entity type:Organization
Organization Name:PSYCHOLOGICAL ASSESSMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:JULES
Authorized Official - Last Name:CHABOT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-972-0040
Mailing Address - Street 1:2107 N BROADWAY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2630
Mailing Address - Country:US
Mailing Address - Phone:714-972-0040
Mailing Address - Fax:714-972-0477
Practice Address - Street 1:2107 N BROADWAY
Practice Address - Street 2:SUITE 207
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2630
Practice Address - Country:US
Practice Address - Phone:714-972-0040
Practice Address - Fax:714-972-0477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY41140103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty