Organization
C Q PSYCHOLOGICAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLINTON EDWARD QUISENBERRY PH.D. (PRESIDENT)
(503) 747-4646
Entity
Organization
Contact information
Practice address
1516 HUDSON ST STE 204, LONGVIEW, WA 98632-3046
(503) 747-4646
(503) 214-8668
Mailing address
1516 HUDSON ST STE 204, LONGVIEW, WA 98632-3046
(503) 747-4646
(503) 214-8668
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12112495
CAQH
—
Enumeration date
02/19/2020
Last updated
02/19/2020
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