Basic Information
| Provider Information | |||||||||
| NPI: | 1831115856 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEARCY | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1530 MAIN STREET | ||||||||
| Address2: | STE. 5 | ||||||||
| City: | RAMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920655244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607896389 | ||||||||
| FaxNumber: | 7607896389 | ||||||||
| Practice Location | |||||||||
| Address1: | 1530 MAIN STREET | ||||||||
| Address2: | STE. 5 | ||||||||
| City: | RAMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920655244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607896389 | ||||||||
| FaxNumber: | 7607896389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 12/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/20/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY11271 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.