Healthcare Provider Details

I. General information

NPI: 1609367598
Provider Name (Legal Business Name): MICHAEL MCGINTY PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 05/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 VILLA LA JOLLA DR STE B204
LA JOLLA CA
92037-1705
US

IV. Provider business mailing address

8950 VILLA LA JOLLA DR STE B204
LA JOLLA CA
92037-1705
US

V. Phone/Fax

Practice location:
  • Phone: 858-900-5848
  • Fax:
Mailing address:
  • Phone: 858-900-5848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberB2017013070
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL MURPHY MCGINTY
Title or Position: PSYCHOLOGIST
Credential: PSY.D.
Phone: 858-900-5848