Provider Demographics
NPI:1679122048
Name:PARISOE-MCSKULIN, VISTA A (PHD)
Entity type:Individual
Prefix:
First Name:VISTA
Middle Name:A
Last Name:PARISOE-MCSKULIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:VISTA
Other - Middle Name:A
Other - Last Name:BASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:741 FRONT ST STE 210
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4992
Mailing Address - Country:US
Mailing Address - Phone:844-244-2840
Mailing Address - Fax:
Practice Address - Street 1:741 FRONT ST STE 208
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4991
Practice Address - Country:US
Practice Address - Phone:844-244-2840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist