Provider Demographics
NPI:1760871826
Name:SOUZA, DEBRA (PHD)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:SOUZA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1688
Mailing Address - Street 2:
Mailing Address - City:SHINGLE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95682-1688
Mailing Address - Country:US
Mailing Address - Phone:559-977-3524
Mailing Address - Fax:
Practice Address - Street 1:3294 ROYAL DR STE 13
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8500
Practice Address - Country:US
Practice Address - Phone:530-677-4404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist