Healthcare Provider Details

I. General information

NPI: 1841390788
Provider Name (Legal Business Name): CHRISTIE LYNN MOREHEAD PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5242 KATELLA AVE SUITE 202
LOS ALAMITOS CA
90720-2820
US

IV. Provider business mailing address

4200 OLIVE AVE
LONG BEACH CA
90807-2442
US

V. Phone/Fax

Practice location:
  • Phone: 562-673-7814
  • Fax:
Mailing address:
  • Phone: 562-673-7814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 17865
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 17865
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY 17865
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY 17865
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: