Healthcare Provider Details

I. General information

NPI: 1295966638
Provider Name (Legal Business Name): JOEL ALAN GERMOND PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 08/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMC HWY 1
SAN LUIS OBISPO CA
93409-0001
US

IV. Provider business mailing address

2919 ORVILLE AVE
CAYUCOS CA
93430-1584
US

V. Phone/Fax

Practice location:
  • Phone: 805-547-7900
  • Fax:
Mailing address:
  • Phone: 805-995-3225
  • Fax: 805-995-3225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY18116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: