Healthcare Provider Details

I. General information

NPI: 1750627626
Provider Name (Legal Business Name): DEBORAH ANNE SPAINE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2012
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20412 BRIAN WAY STE 1
TEHACHAPI CA
93561-8702
US

IV. Provider business mailing address

PO BOX 632
TEHACHAPI CA
93581-0632
US

V. Phone/Fax

Practice location:
  • Phone: 661-823-0661
  • Fax:
Mailing address:
  • Phone: 661-221-2493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY12760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: