Healthcare Provider Details

I. General information

NPI: 1487940839
Provider Name (Legal Business Name): BOBIE LYNN STALLCUP PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24900 HIGHWAY 202
TEHACHAPI CA
93561-5558
US

IV. Provider business mailing address

24900 HIGHWAY 202
TEHACHAPI CA
93561-5558
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-4402
  • Fax: 661-823-3362
Mailing address:
  • Phone: 661-822-4402
  • Fax: 661-823-3362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY22235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: