Healthcare Provider Details

I. General information

NPI: 1427117670
Provider Name (Legal Business Name): BARBARA LYNN SPRAYREGEN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16052 BEACH BLVD #212
HUNTINGTON BEACH CA
92647
US

IV. Provider business mailing address

4835 E ANAHEIM ST #105
LONG BEACH CA
90804-3270
US

V. Phone/Fax

Practice location:
  • Phone: 714-375-1045
  • Fax: 714-375-1046
Mailing address:
  • Phone: 562-498-7062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number16761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: