Provider Demographics
NPI:1144256702
Name:NORSELL, M RYNDA (PHD)
Entity type:Individual
Prefix:DR
First Name:M
Middle Name:RYNDA
Last Name:NORSELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:M
Other - Middle Name:RYNDA
Other - Last Name:NORSELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:10556 COMBIE RD
Mailing Address - Street 2:PMB 6511
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8908
Mailing Address - Country:US
Mailing Address - Phone:530-320-5886
Mailing Address - Fax:530-888-0960
Practice Address - Street 1:204 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-4711
Practice Address - Country:US
Practice Address - Phone:530-320-5886
Practice Address - Fax:530-888-0960
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10382103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL103820Medicare ID - Type Unspecified