Healthcare Provider Details

I. General information

NPI: 1861573172
Provider Name (Legal Business Name): KRYSCLIE MAYER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 ATLANTIC AVE SUITE 430
LONG BEACH CA
90807-2218
US

IV. Provider business mailing address

2099 N COLLINS BLVD SUITE 100
RICHARDSON TX
75080-2698
US

V. Phone/Fax

Practice location:
  • Phone: 562-428-3266
  • Fax: 562-428-3288
Mailing address:
  • Phone: 972-437-4698
  • Fax: 972-671-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 17317
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: