Healthcare Provider Details

I. General information

NPI: 1144256702
Provider Name (Legal Business Name): M RYNDA NORSELL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: M RYNDA NORSELL PH.D.

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W MAIN ST
GRASS VALLEY CA
95945-4711
US

IV. Provider business mailing address

10556 COMBIE RD PMB 6511
AUBURN CA
95602-8908
US

V. Phone/Fax

Practice location:
  • Phone: 530-320-5886
  • Fax: 530-888-0960
Mailing address:
  • Phone: 530-320-5886
  • Fax: 530-888-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10382
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY10382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: