Provider Demographics
NPI:1285067496
Name:CUYSON, CARLYNNE JOIE
Entity type:Individual
Prefix:
First Name:CARLYNNE
Middle Name:JOIE
Last Name:CUYSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2494 VIA PUERTA DR
Mailing Address - Street 2:
Mailing Address - City:BAY POINT
Mailing Address - State:CA
Mailing Address - Zip Code:94565-7664
Mailing Address - Country:US
Mailing Address - Phone:925-361-2328
Mailing Address - Fax:
Practice Address - Street 1:2494 VIA PUERTA DR
Practice Address - Street 2:
Practice Address - City:BAY POINT
Practice Address - State:CA
Practice Address - Zip Code:94565-7664
Practice Address - Country:US
Practice Address - Phone:925-361-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA118888106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program