Provider Demographics
NPI:1679171573
Name:PERCEPTION DYNAMICS INCORPORATED
Entity type:Organization
Organization Name:PERCEPTION DYNAMICS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-903-6009
Mailing Address - Street 1:PO BOX 231305
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92023-1305
Mailing Address - Country:US
Mailing Address - Phone:310-903-6009
Mailing Address - Fax:
Practice Address - Street 1:828 SANTA INEZ
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1523
Practice Address - Country:US
Practice Address - Phone:310-903-6009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14645900OtherCAQH PROVIDER