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General NPI Number Information
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NPI Number | 1427169648
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Entity Type | Individual
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Provider Name | R SCOTT SULLENDER PHD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15 AUSTIN
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City | SAN ANSELMO
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State | CA
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Zip | 94960-2925
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Country | US
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Telephone | 415-258-6652
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Fax | 415-256-9801
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Provider Business Mailing Address
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Address Line | 105 SEMINARY RD
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City | SAN ANSELMO
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State | CA
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Zip | 94960-2925
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Country | US
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Telephone | 415-258-6652
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Fax | 415-256-9801
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY8931
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License Number State | CA
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