Provider Demographics
NPI:1104004571
Name:EWING, TROY (PSYD)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:EWING
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 FULTON AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4500
Mailing Address - Country:US
Mailing Address - Phone:916-474-9337
Mailing Address - Fax:
Practice Address - Street 1:900 FULTON AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4500
Practice Address - Country:US
Practice Address - Phone:916-474-9337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20089103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist