Healthcare Provider Details

I. General information

NPI: 1700383825
Provider Name (Legal Business Name): ASCENT PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4652 BANNOCK AVE
SAN DIEGO CA
92117-2922
US

IV. Provider business mailing address

4652 BANNOCK AVE
SAN DIEGO CA
92117-2922
US

V. Phone/Fax

Practice location:
  • Phone: 614-323-2617
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number26523
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. LAUREN GASSIER
Title or Position: OWNER
Credential:
Phone: 614-323-2617