Jack Warren Ito is a Psychologist in 29 Palms, California. Jack Warren Ito practices all healthcare services and medical treatments related to Psychologist. The NPI Number for Jack Warren Ito is 1710966593. The last update date is 2007-11-01.
Jack Warren Ito's current location address is Po Box 63, 29 Palms, California. You can contact this provider via phone number 7608302782 and fax number 7244071201. The mailing address for Jack Warren Ito is Po Box 63, 29 Palms, California. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Jack Warren Ito |
|---|---|
| Address | Po Box 63, 29 Palms, California |
| Phone Number | 7608302782 |
| Fax Number | 7244071201 |
| Sole Proprietor | N |
| Credentials | PHD |
NPI Number Detail
| NPI Number | 1710966593 |
|---|---|
| Provider Enumeration Date | 2006-01-11 |
| Last Updated Date | 2007-11-01 |
Provider Mailing Address Detail
| Address | Po Box 63 |
|---|---|
| City | 29 Palms |
| State | California (CA) |
| Post Code | 92277 |
| Phone Number | 7608302782 |
| Fax Number | 7244071201 |
Provider's Primary Taxonomy Detail
| Speciality | Psychologist |
|---|---|
| Taxonomy | 103T00000X |
| Licence No | PS008530L |
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Definition: A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and proce |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 16536380004 | PA | -- | |
| 163751 | PA | VALUE BEHAVIORAL HEALTH | |
| 959098 | PA | HIGHMARK PROVIDER NUMBER | |
| A771081 | PA | VALUE BEHAVIORAL HEALTH |
Post Comment/ Review Below
What is Jack Warren Ito's primary field of medical specialization, and what is the corresponding taxonomy classification code for this area of expertise?
The primary field of medical specialization for Jack Warren Ito is Psychologist, and the taxonomy classification code that categorizes this area of expertise is 103T00000X.
On what date did Jack Warren Ito receive its 1710966593 assignment from the Centers for Medicare & Medicaid Services?
The Jack Warren Ito was assigned its 1710966593 on 2006-01-11, which is the date when this unique identifier was issued to the organization by the Centers for Medicare & Medicaid Services.
On what date did the Centers for Medicare & Medicaid Services assign the 1710966593 to Jack Warren Ito?
The Centers for Medicare & Medicaid Services assigned the 1710966593 to Jack Warren Ito on 2006-01-11.
When was the information related to Jack Warren Ito most recently updated or refreshed?
The details pertaining to the Jack Warren Ito, including its address, specialty, and other relevant information, were last updated or refreshed on 2007-11-01.
As of what date was the information regarding Jack Warren Ito, such as address, specialty, and other details, last verified and confirmed to be up-to-date?
The information related to Jack Warren Ito, including its address, specialty, and other relevant details, was last verified and confirmed to be up-to-date on 2007-11-01.
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