Provider Demographics
NPI:1043616121
Name:GENUINE PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:GENUINE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:VIERS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:858-386-0993
Mailing Address - Street 1:3636 4TH AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4280
Mailing Address - Country:US
Mailing Address - Phone:858-386-0993
Mailing Address - Fax:858-408-7416
Practice Address - Street 1:3636 4TH AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4280
Practice Address - Country:US
Practice Address - Phone:858-386-0993
Practice Address - Fax:858-408-7416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2015-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25309103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty