Provider Demographics
NPI:1922372853
Name:JOSEPH S. BUSEY, PH.D., A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:JOSEPH S. BUSEY, PH.D., A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:SIPFLE
Authorized Official - Last Name:BUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:530-529-5868
Mailing Address - Street 1:12945 PEACH TREE LN
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-7807
Mailing Address - Country:US
Mailing Address - Phone:530-529-5868
Mailing Address - Fax:530-529-4031
Practice Address - Street 1:12945 PEACH TREE LN
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-7807
Practice Address - Country:US
Practice Address - Phone:530-529-5868
Practice Address - Fax:530-529-4031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3413103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00PL34130Medicare PIN