Provider Demographics
NPI:1043541014
Name:SACRAMENTO CHILD PSYCHIATRY
Entity Type:Organization
Organization Name:SACRAMENTO CHILD PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:YAEWON
Authorized Official - Last Name:THYGESON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-580-5769
Mailing Address - Street 1:PO BOX 15321
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95851-0321
Mailing Address - Country:US
Mailing Address - Phone:916-580-5769
Mailing Address - Fax:
Practice Address - Street 1:1111 EXPOSITION BLVD STE 700
Practice Address - Street 2:SUITE 102
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4335
Practice Address - Country:US
Practice Address - Phone:916-580-5769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108395261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health