| Center For Thoughtful Lasting Change | |
|
9606 Tierra Grande #201 San Diego CA 92126 | |
| (619) 369-5050 | |
| (877) 485-5961 |
| Full Name | Center For Thoughtful Lasting Change |
|---|---|
| Speciality | Psychologist |
| Location | 9606 Tierra Grande #201, San Diego, California |
| Authorized Official Name and Position | Sherry G Casper (OWNER) |
| Authorized Official Contact | 6193695050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Thoughtful Lasting Change Po Box 421146 San Diego CA 92142 Ph: (619) 369-5050 | Center For Thoughtful Lasting Change 9606 Tierra Grande #201 San Diego CA 92126 Ph: (619) 369-5050 |
| NPI Number | 1548597438 |
|---|---|
| Provider Enumeration Date | 11/12/2009 |
| Last Update Date | 03/30/2022 |
| Certification Date | 03/30/2022 |
| Medicare PECOS PAC ID | 4789096306 |
|---|---|
| Medicare Enrollment ID | O20201223000966 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548597438 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY20550 (California) | Primary |
| Provider Name | Sherry G Casper |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1255668455 PECOS PAC ID: 5698187219 Enrollment ID: I20201223001030 |
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