NPIMap

Organization Active NPI

Gary S. Cannyon Psychological Service Center

  • Clinical Psychologist
  • Fresno, CA
National Provider Identifier
1295936771
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY16998 Issued in CA
Legal business name
GARY S. CANNYON PSYCHOLOGICAL SERVICE CENTER
Practice address
5130 E Clinton Way
Fresno, CA 93727-2014
Phone
(559) 253-2277
Fax
(559) 253-2298
NPI assigned
May 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Dale S. White, PSY16998
Title
Director
Phone
(559) 253-2260

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X PSY16998 CA Primary

Addresses

Primary practice location

5130 E Clinton Way
Fresno, CA 93727-2014

Mailing address

5130 E Clinton Way
Fresno, CA 93727-2014
Phone (559) 253-2277

Other names 1

  • Alliant International University Other name

National Provider Directory

National Provider Directory
Tax ID family
Institute on Violence Abuse Trauma Alliant International Univers18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295936771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5130 E CLINTON WAY",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937272014",
            "telephone_number": "559-253-2277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5130 E CLINTON WAY",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937272014",
            "telephone_number": "559-253-2277",
            "fax_number": "559-253-2298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY S. CANNYON PSYCHOLOGICAL SERVICE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "559-253-2260",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY16998"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY16998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alliant International University",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.