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General NPI Number Information
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NPI Number | 1629405360
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Entity Type | Individual
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Provider Name | BARRY VISSELL
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Gender | Male
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Dates
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Enumeration Date | 09/26/2013
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Last Update Date | 09/26/2013
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Provider Practice Location Address
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Address Line | 755 REDWOOD HEIGHTS RD
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City | APTOS
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State | CA
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Zip | 95003-9587
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Country | US
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Telephone | 831-684-2130
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Fax |
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Provider Business Mailing Address
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Address Line | 755 REDWOOD HEIGHTS RD
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City | APTOS
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State | CA
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Zip | 95003-9587
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Country | US
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Telephone |
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | G-028812
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License Number State | CA
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