Provider Demographics
NPI:1144556762
Name:CARLEY, RICHARD SCOT (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SCOT
Last Name:CARLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8500
Mailing Address - Street 2:
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-8500
Mailing Address - Country:US
Mailing Address - Phone:559-935-4900
Mailing Address - Fax:559-935-7056
Practice Address - Street 1:24511 W JAYNE AVE
Practice Address - Street 2:
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-9503
Practice Address - Country:US
Practice Address - Phone:559-934-3075
Practice Address - Fax:559-934-3095
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22931103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical