Update this page – If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS.
Organization
WELL STREET PSYCHOLOGICAL INC.
Active
Organization
WELL STREET PSYCHOLOGICAL INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARTIN J EATON PH.D (CEO/OWNER)
(714) 730-9355
Entity
Organization
Contact information
Practice address
100 S IMPERIAL HWY, ANAHEIM, CA 92807-3943
(714) 730-9355
(714) 730-9355
Mailing address
100 S IMPERIAL HWY, ANAHEIM, CA 92807-3943
(714) 730-9355
(714) 730-9355
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
PSY15533
CA
103TC0700X
Clinical Psychologist
Primary
PSY15533
CA
103TC1900X
Counseling Psychologist
PSY15533
CA
103TC2200X
Clinical Child & Adolescent Psychologist
PSY15533
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PSY15533
PSYCHOLOGIST LICENSE
CA
Enumeration date
08/06/2016
Last updated
08/06/2016
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up