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General NPI Number Information
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NPI Number | 1295437051
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Entity Type | Organization
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Legal Business Name | THE COUPLES WELLNESS CENTER
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Dates
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Enumeration Date | 03/17/2023
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Last Update Date | 03/17/2023
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Provider Practice Location Address
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Address Line | 4065 IVEY VISTA WAY
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City | OCEANSIDE
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State | CA
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Zip | 92057-7663
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Country | US
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Telephone | 661-567-7707
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Fax |
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Provider Business Mailing Address
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Address Line | 1895 AVENIDA DEL ORO UNIT 4138
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City | OCEANSIDE
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State | CA
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Zip | 92052-0207
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Country | US
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Telephone | 661-567-7707
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | SUSAN IYICAN
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Credential | PH.D
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Telephone | 661-567-7707
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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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