MEDICARE: DR. CLARISSA J GOSNEY PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY29633	CA

General Provider Information

NPI Number	:	1285147140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLARISSA J GOSNEY PSYD

Provider Business Mailing Address
First Line	:	3785 HARRISON BLVD STE 4
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-2072
Country	:	US
Telephone Number	:	619-800-3811
Fax Number	:

Provider Business Practice Location Address
First Line	:	3785 HARRISON BLVD STE 4
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-2072
Country	:	US
Telephone Number	:	619-800-3811
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2017
Last Update Date	:	01/14/2026

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