Provider Demographics
NPI:1306020011
Name:CAROL VISSER, PHD INC
Entity Type:Organization
Organization Name:CAROL VISSER, PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:VISSER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:530-889-8480
Mailing Address - Street 1:122 EAST ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5119
Mailing Address - Country:US
Mailing Address - Phone:530-889-8480
Mailing Address - Fax:
Practice Address - Street 1:122 EAST ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5119
Practice Address - Country:US
Practice Address - Phone:530-889-8480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8619261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY8619OtherCLINICAL PSYCH LIC