Healthcare Provider Details

I. General information

NPI: 1174548242
Provider Name (Legal Business Name): DR. KATHY LYNN PARISH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 N SUNSET AVE
WEST COVINA CA
91790-1244
US

IV. Provider business mailing address

1609 BUSHNELL AVE
SOUTH PASADENA CA
91030-4901
US

V. Phone/Fax

Practice location:
  • Phone: 800-257-8715
  • Fax:
Mailing address:
  • Phone: 626-441-4861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY7516
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: