Healthcare Provider Details

I. General information

NPI: 1811543747
Provider Name (Legal Business Name): DR. SCOGGINS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 N PREUSS AVE
CLOVIS CA
93619-7464
US

IV. Provider business mailing address

2023 N PREUSS AVE
CLOVIS CA
93619-7464
US

V. Phone/Fax

Practice location:
  • Phone: 559-246-8679
  • Fax:
Mailing address:
  • Phone: 559-246-8679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHELLE D SCOGGINS
Title or Position: OWNER
Credential: PSY.D.
Phone: 559-246-8679