Basic Information
| Provider Information | |||||||||
| NPI: | 1841532298 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PSYCARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4550 KEARNY VILLA RD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582791223 | ||||||||
| FaxNumber: | 8584677161 | ||||||||
| Practice Location | |||||||||
| Address1: | 2120 THIBODO RD | ||||||||
| Address2: | |||||||||
| City: | VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920817901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585695642 | ||||||||
| FaxNumber: | 8584677161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2013 | ||||||||
| LastUpdateDate: | 03/25/2013 | ||||||||
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| AuthorizedOfficialLastName: | LUDWIG | ||||||||
| AuthorizedOfficialFirstName: | JENIFER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8582791223 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 52445 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.