C Q Psychological PLLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

C Q PSYCHOLOGICAL PLLC

Practice address

1516 Hudson St Ste 204
Longview, WA 98632-3046

Phone

(503) 747-4646

Fax

(503) 214-8668

NPI assigned

Feb 19, 2020

Last updated

Feb 19, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Clinton Edward Quisenberry, PH.D.NPI 1710205232

Title

President

Phone

(503) 747-4646

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA, OR2 enrollments

Enrollment records 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Clinton Edward Quisenberry, PH.D.

  • Psychologist
  • Tigard, OR
  • NPI 1710205232

  WA

  Medicare reassignment NPD Authorized official
• Mackenzie L Taylor, LICSW

  • Clinical Social Worker
  • Longview, WA
  • NPI 1114166337
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1582070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1619500477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1516 HUDSON ST STE 204",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323046",
            "telephone_number": "503-747-4646",
            "fax_number": "503-214-8668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1516 HUDSON ST STE 204",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323046",
            "telephone_number": "503-747-4646",
            "fax_number": "503-214-8668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C Q PSYCHOLOGICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-19",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A",
        "authorized_official_last_name": "QUISENBERRY",
        "authorized_official_first_name": "CLINTON",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-747-4646",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12112495",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brenda Butler, PHARMD
• Charlotte M Button
• Maddox Byfield-Warren
• Tina Marie Byrd, LMP
• C J Bartness DC Inc PS
• Cabel a McDonald DDS PLLC (Longview Oral & Maxillofacial Surgery)
• Steven X. Cabrales, M.D.
• Kharece Tevis Cadwell, BS, R-AAC
• Cassie Cady
• Lauren Cai, D.D.S, P.C.

• Psychologist in Longview, WA
• Providers in Longview, WA by specialty
• Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.