| Carol Visser, Phd Inc | |
|
122 East St Auburn CA 95603-5119 | |
| (530) 889-8480 | |
| Not Available |
| Full Name | Carol Visser, Phd Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 122 East St, Auburn, California |
| Authorized Official Name and Position | Carol J Visser (PRESIDENT) |
| Authorized Official Contact | 5308898480 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carol Visser, Phd Inc 122 East St Auburn CA 95603-5119 Ph: (530) 889-8480 | Carol Visser, Phd Inc 122 East St Auburn CA 95603-5119 Ph: (530) 889-8480 |
| NPI Number | 1306020011 |
|---|---|
| Provider Enumeration Date | 12/18/2007 |
| Last Update Date | 12/18/2007 |
| Medicare PECOS PAC ID | 2961561600 |
|---|---|
| Medicare Enrollment ID | O20130308000366 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306020011 | NPI | - | NPPES |
| PSY8619 | Other | CA | CLINICAL PSYCH LIC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | PSY8619 (California) | Primary |
| Provider Name | Carol J Visser |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1831362011 PECOS PAC ID: 8628137361 Enrollment ID: I20081110000408 |
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