Provider Demographics
NPI:1811122245
Name:PSYCHOLOGICAL ASSOCIATES, INC
Entity type:Organization
Organization Name:PSYCHOLOGICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:EBERSOLE
Authorized Official - Last Name:RIPPY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:949-521-1140
Mailing Address - Street 1:1 MCGWIRE RD
Mailing Address - Street 2:UNIT 369
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0328
Mailing Address - Country:US
Mailing Address - Phone:949-521-1140
Mailing Address - Fax:848-218-9616
Practice Address - Street 1:26441 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8528
Practice Address - Country:US
Practice Address - Phone:949-521-1140
Practice Address - Fax:949-218-9616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2013-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC17775106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty