Provider Demographics
NPI:1417318569
Name:SCOGGINS, MICHELLE (PSYD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SCOGGINS
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 1:2023 N PREUSS AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-7464
Mailing Address - Country:US
Mailing Address - Phone:209-756-1915
Mailing Address - Fax:
Practice Address - Street 1:2023 N PREUSS AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-7464
Practice Address - Country:US
Practice Address - Phone:559-246-8679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X103TC0700X
CA29566103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical