Provider Demographics
NPI:1568890606
Name:MARILEE L.M. WASELL, PH.D. CLINICAL AND CONSULTING PSYCHOLOGY PC
Entity Type:Organization
Organization Name:MARILEE L.M. WASELL, PH.D. CLINICAL AND CONSULTING PSYCHOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILEE
Authorized Official - Middle Name:LAYNE
Authorized Official - Last Name:WASELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-200-3658
Mailing Address - Street 1:3579 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4912
Mailing Address - Country:US
Mailing Address - Phone:619-200-3658
Mailing Address - Fax:619-717-8710
Practice Address - Street 1:3579 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4912
Practice Address - Country:US
Practice Address - Phone:619-200-3658
Practice Address - Fax:619-717-8710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20864103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty