Provider Demographics
NPI:1992854798
Name:MUSE, DEBRA KAYE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:KAYE
Last Name:MUSE
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 1:957 WEST ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1782
Mailing Address - Country:US
Mailing Address - Phone:805-546-8836
Mailing Address - Fax:
Practice Address - Street 1:684 HIGUERA ST
Practice Address - Street 2:SUITE C
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3550
Practice Address - Country:US
Practice Address - Phone:805-545-9441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12511103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP12511Medicare ID - Type UnspecifiedPSYCHOLOGIST