Active NPI
Amy Mouanoutoua, PH.D.
- Clinical Psychologist
- Fresno, CA
National Provider Identifier
1568096121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY30912
- Practice address
- 2109 W Bullard Ave Ste 121
Fresno, CA 93711-1258 - Phone
- (559) 246-8679
- NPI assigned
- Feb 23, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY30912 | CA | Primary |
Addresses
Primary practice location
2109 W Bullard Ave Ste 121
Fresno, CA 93711-1258
Mailing address
2109 W Bullard Ave Ste 121
Fresno, CA 93711-1258
Phone (559) 246-8679
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30912 | CA | MD | Mental Health Counselor |
| PSY30912 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. Scoggins, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychologist
- Clovis, CA
- NPI 1811543747
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582416000000",
"number": "1568096121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2109 W BULLARD AVE STE 121",
"city": "FRESNO",
"state": "CA",
"postal_code": "937111258",
"telephone_number": "559-246-8679"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2109 W BULLARD AVE STE 121",
"city": "FRESNO",
"state": "CA",
"postal_code": "937111258",
"telephone_number": "559-246-8679"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOUANOUTOUA",
"first_name": "AMY",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-02-23",
"last_updated": "2020-02-23",
"certification_date": "2020-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY30912",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.