Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY17057 | CA |
Y | 103G00000X | Clinical Psychologist | PSY17057 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY17057 | CA |
N | 103TH0004X | Health Psychologist | PSY17057 | CA |
NPI | 1235451840 |
---|---|
Provider Name | Laurel M. Sugden |
First Address | Anaheim Hills, CA 92808-1356 |
Second Address | Newport Beach, CA 92660-7802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2010 |
Last Update Date | 23/02/2010 |