# C Q PSYCHOLOGICAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619500477
- **Authorized official:** DR. CLINTON EDWARD QUISENBERRY PH.D. (PRESIDENT)
- **Authorized official phone:** (503) 747-4646

## Contact information

- **Practice address:** 1516 HUDSON ST STE 204, LONGVIEW, WA 98632-3046
- **Practice address phone:** (503) 747-4646
- **Practice address fax:** (503) 214-8668
- **Mailing address:** 1516 HUDSON ST STE 204, LONGVIEW, WA 98632-3046
- **Mailing address phone:** (503) 747-4646
- **Mailing address fax:** (503) 214-8668

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | Yes |
| 103T00000X | Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 02/19/2020
- **Last updated:** 02/19/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 12112495 | CAQH | — |