Healthcare Provider Details

I. General information

NPI: 1346949229
Provider Name (Legal Business Name): PSYCHOLOGY SOLUTIONS FOR LIFE A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 02/28/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 NOB HILL DR
WALNUT CREEK CA
94596-6707
US

IV. Provider business mailing address

160 ALAMO PLZ UNIT 583
ALAMO CA
94507-4030
US

V. Phone/Fax

Practice location:
  • Phone: 925-785-5559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: BROOKE OTTERSON
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 925-785-5559