=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588732952
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAMI VISSELL PH.D., LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2006
-----------------------------------------------------
Last Update Date | 02/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6630 HIGHWAY 9 STE 204
-----------------------------------------------------
City | FELTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95018-9711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-204-8891
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10241 REDWOOD DR
-----------------------------------------------------
City | FELTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95018-8820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 113597
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------