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Organization
OWENS VALLEY WELLNESS
Active
Organization
OWENS VALLEY WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB EIDE PSY.D. (CLINICAL PSYCHOLOGIST/OWNER)
(760) 920-6210
Entity
Organization
Contact information
Practice address
686 W LINE ST, BISHOP, CA 93514-3315
(760) 920-6210
Mailing address
686 W LINE ST, BISHOP, CA 93514-3315
(760) 920-6210
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY27059
CA
Other
Enumeration date
01/28/2016
Last updated
01/28/2016
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