Basic Information
| Provider Information | |||||||||
| NPI: | 1265660112 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOO | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 155 N FRESNO ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937012302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594996580 | ||||||||
| FaxNumber: | 5594996581 | ||||||||
| Practice Location | |||||||||
| Address1: | 155 N FRESNO ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937012302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594996580 | ||||||||
| FaxNumber: | 5594996581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2009 | ||||||||
| LastUpdateDate: | 05/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | PSY22726 | CA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 103T00000X | PSY 22726 | CA | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | PSY227260 | 05 | CA | MEDICAID |