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General NPI Number Information
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NPI Number | 1205459948
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Entity Type | Organization
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Legal Business Name | MISSION PSYCHOLOGICAL SERVICES, INC
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Dates
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Enumeration Date | 05/27/2020
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Last Update Date | 05/27/2020
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Provider Practice Location Address
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Address Line | 7465 MISSION GORGE RD STE 150
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City | SAN DIEGO
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State | CA
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Zip | 92120-1301
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Country | US
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Telephone | 619-900-1986
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Fax |
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Provider Business Mailing Address
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Address Line | 7465 MISSION GORGE RD STE 150
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City | SAN DIEGO
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State | CA
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Zip | 92120-1301
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Country | US
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Telephone | 619-900-1986
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | STEPHANIE ORBON
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Credential | PHD
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Telephone | 619-900-1986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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