Provider Demographics
NPI:1881307544
Name:STEPHANIE KNATZ PECK PHD PSYCHOLOGICAL SERVICES INC
Entity type:Organization
Organization Name:STEPHANIE KNATZ PECK PHD PSYCHOLOGICAL SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNATZ PECK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-255-4095
Mailing Address - Street 1:1010 TURQUOISE ST STE 303
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1268
Mailing Address - Country:US
Mailing Address - Phone:858-255-4095
Mailing Address - Fax:619-566-3845
Practice Address - Street 1:1010 TURQUOISE ST STE 303
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-1268
Practice Address - Country:US
Practice Address - Phone:858-255-4095
Practice Address - Fax:619-566-3845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-27
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty