| Lic Marriage & | |
|
4900 California Ave 330-b Bakersfield CA 93309-7024 | |
| (661) 326-8167 | |
| (661) 326-8221 |
| Full Name | Lic Marriage & |
|---|---|
| Speciality | Psychologist |
| Location | 4900 California Ave, Bakersfield, California |
| Authorized Official Name and Position | Mccoy Dean Haddock (CEO) |
| Authorized Official Contact | 6613268167 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lic Marriage & Po Box 82096 Bakersfield CA 93380-2096 Ph: (661) 326-8167 | Lic Marriage & 4900 California Ave 330-b Bakersfield CA 93309-7024 Ph: (661) 326-8167 |
| NPI Number | 1346457157 |
|---|---|
| Provider Enumeration Date | 05/17/2007 |
| Last Update Date | 04/03/2014 |
| Medicare PECOS PAC ID | 5294875613 |
|---|---|
| Medicare Enrollment ID | O20091216000205 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346457157 | NPI | - | NPPES |
| Provider Name | Mccoy D Haddock |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649495920 PECOS PAC ID: 4789723214 Enrollment ID: I20091123000424 |
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