Healthcare Provider Details

I. General information

NPI: 1417318569
Provider Name (Legal Business Name): MICHELLE SCOGGINS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
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: 209-756-1915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number103T00000X
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number29566
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: