Provider Demographics
NPI:1528505237
Name:TORY D. PEPPER, PH.D., A PROFESSIONAL PSYCHOLOGY CORPORATION
Entity type:Organization
Organization Name:TORY D. PEPPER, PH.D., A PROFESSIONAL PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TORY
Authorized Official - Middle Name:DEBORAH
Authorized Official - Last Name:PEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-695-2237
Mailing Address - Street 1:9683 TIERRA GRANDE ST
Mailing Address - Street 2:105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-6503
Mailing Address - Country:US
Mailing Address - Phone:858-695-2237
Mailing Address - Fax:858-695-2238
Practice Address - Street 1:9683 TIERRA GRANDE ST
Practice Address - Street 2:105
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-6503
Practice Address - Country:US
Practice Address - Phone:858-695-2237
Practice Address - Fax:858-695-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18383103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty