Provider Demographics
NPI:1982607784
Name:DANIEL D. SHIRBROUN, PHD, INC, PSYCHOLOGIST
Entity Type:Organization
Organization Name:DANIEL D. SHIRBROUN, PHD, INC, PSYCHOLOGIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SHIRBROUN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:760-369-7166
Mailing Address - Street 1:54045 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-8311
Mailing Address - Country:US
Mailing Address - Phone:760-365-2588
Mailing Address - Fax:760-369-7167
Practice Address - Street 1:7293 DUMOSA AVE
Practice Address - Street 2:STE 8
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3700
Practice Address - Country:US
Practice Address - Phone:760-369-7166
Practice Address - Fax:760-369-7167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4161103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty