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NPI Code Detail

MEDICARE: MARCELLE PRATT PSYD

MEDICARE: MARCELLE PRATT 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
1103TC0700XClinical PsychologistPSY 22664CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1770288900OTHERCATAX ID

General Provider Information

NPI Number : 1598810079
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARCELLE PRATT PSYD
Provider Business Mailing Address
First Line : 5588 N PALM AVE STE I-1
Second Line :
City : FRESNO
State : CA
Zip : 93704-1913
Country : US
Telephone Number : 559-997-6353
Fax Number : 559-272-4898
Provider Business Practice Location Address
First Line : 5588 N PALM AVE STE I-1
Second Line :
City : FRESNO
State : CA
Zip : 93704-1913
Country : US
Telephone Number : 559-997-6353
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 08/18/2011

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Directions to “ MARCELLE PRATT PSYD” Practice Location

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