Provider Demographics
NPI:1912684507
Name:MARY E EASON PH D A PSYCHOLOGICAL SERVICES CORPORATION
Entity type:Organization
Organization Name:MARY E EASON PH D A PSYCHOLOGICAL SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:EASON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-879-5868
Mailing Address - Street 1:305 N HARBOR BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1901
Mailing Address - Country:US
Mailing Address - Phone:714-879-5868
Mailing Address - Fax:714-879-5858
Practice Address - Street 1:305 N HARBOR BLVD STE 202
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1901
Practice Address - Country:US
Practice Address - Phone:714-879-5868
Practice Address - Fax:714-879-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-05
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty