Healthcare Provider Details

I. General information

NPI: 1679171573
Provider Name (Legal Business Name): PERCEPTION DYNAMICS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 SANTA INEZ
SOLANA BEACH CA
92075-1523
US

IV. Provider business mailing address

PO BOX 231305
ENCINITAS CA
92023-1305
US

V. Phone/Fax

Practice location:
  • Phone: 310-903-6009
  • Fax:
Mailing address:
  • Phone: 310-903-6009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. TERI LAWTON
Title or Position: CEO, OWNER
Credential: PHD
Phone: 310-903-6009