Healthcare Provider Details

I. General information

NPI: 1417137274
Provider Name (Legal Business Name): CATHY LYNN BISSETT PSYD, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 W KORTSEN RD STE 202
CASA GRANDE AZ
85122-5923
US

IV. Provider business mailing address

PO BOX 172
MARICOPA AZ
85139-0049
US

V. Phone/Fax

Practice location:
  • Phone: 928-274-0294
  • Fax:
Mailing address:
  • Phone: 928-274-0294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number003917
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number003917
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: