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General NPI Number Information
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NPI Number | 1780411462
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Entity Type | Organization
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Legal Business Name | HEAD AND HEART PSYCHOLOGY, INC.
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Dates
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Enumeration Date | 09/17/2024
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 302 WASHINGTON ST # 813
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City | SAN DIEGO
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State | CA
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Zip | 92103-2110
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Country | US
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Telephone | 619-630-0899
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Fax |
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Provider Business Mailing Address
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Address Line | 302 WASHINGTON ST # 813
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City | SAN DIEGO
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State | CA
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Zip | 92103-2110
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Country | US
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Telephone | 619-630-0899
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. MICHELLE LYNN BALES
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Credential | PSY.D.
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Telephone | 619-630-0899
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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 |
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License Number State |
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Taxonomy #2
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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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