MEDICARE: ASCENSION PSYCHOLOGY, INC.

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1952824898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCENSION PSYCHOLOGY, INC.

Provider Business Mailing Address
First Line	:	2729 4TH AVE STE 3
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-6223
Country	:	US
Telephone Number	:	619-733-7163
Fax Number	:

Provider Business Practice Location Address
First Line	:	2729 4TH AVE STE 3
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-6223
Country	:	US
Telephone Number	:	619-733-7163
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. LAUREN E PICHARD
Credential	:	PSYD
Telephone Number	:	619-733-7163

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	07/21/2022

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