| C Q Psychological Pllc | |
|
1516 Hudson St Ste 204 Longview WA 98632-3046 | |
| (503) 747-4646 | |
| (503) 214-8668 |
| Full Name | C Q Psychological Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 1516 Hudson St Ste 204, Longview, Washington |
| Authorized Official Name and Position | Clinton Edward Quisenberry (PRESIDENT) |
| Authorized Official Contact | 5037474646 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| C Q Psychological Pllc 1516 Hudson St Ste 204 Longview WA 98632-3046 Ph: (503) 747-4646 | C Q Psychological Pllc 1516 Hudson St Ste 204 Longview WA 98632-3046 Ph: (503) 747-4646 |
| NPI Number | 1619500477 |
|---|---|
| Provider Enumeration Date | 02/19/2020 |
| Last Update Date | 02/19/2020 |
| Certification Date | 02/19/2020 |
| Medicare PECOS PAC ID | 7416384805 |
|---|---|
| Medicare Enrollment ID | O20200225000608 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619500477 | NPI | - | NPPES |
| 12112495 | Other | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Clinton E Quisenberry |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1710205232 PECOS PAC ID: 7810182003 Enrollment ID: I20101112001284 |
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