Individual
MICKEY J PRICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
919 7TH ST, BROOKINGS, OR 97415-9209
(541) 787-8776
Mailing address
919 7TH ST, BROOKINGS, OR 97415-9209
(541) 787-8776
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY20090
CA
Other
Enumeration date
02/16/2012
Last updated
02/16/2012
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