Individual provider · NPI-1

Dr. Shirley Grace Roark, Ph.D.

Psychologist, Clinical · Indio, CA

NPI number1417003104
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1417003104
Entity type
Individual (NPI-1)
Name
Dr. Shirley Grace Roark
Credential
Ph.D.
Sex
Female
Sole proprietor
Yes
Enumeration date
Jan 26, 2007
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
103TC0700X Psychologist, ClinicalPSY17934CAYes

Other names

  • Shirley Grace Roark (Other Name)

Practice location

83203 Indio Blvd
Suite 2
Indio, CA 92201-4700

Phone 760-342-1420 · Fax 760-342-1429

Mailing address

3250 Wilshire Blvd
Suite 930
Los Angeles, CA 90010-1438

Phone 213-739-0019 · Fax 213-739-0091

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