Provider Demographics
NPI:1184662850
Name:PLEASANTS, KARLYN MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KARLYN
Middle Name:MARIE
Last Name:PLEASANTS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 WELLESLEY ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-4431
Mailing Address - Country:US
Mailing Address - Phone:619-708-4033
Mailing Address - Fax:619-466-2609
Practice Address - Street 1:5520 WELLESLEY ST
Practice Address - Street 2:SUITE 107
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-4431
Practice Address - Country:US
Practice Address - Phone:619-708-4033
Practice Address - Fax:619-466-2609
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19378103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q26469Medicare UPIN
CP19378Medicare ID - Type Unspecified