Provider Demographics
NPI:1285000174
Name:WILLIAM SHRYER
Entity Type:Organization
Organization Name:WILLIAM SHRYER
Other - Org Name:BLACKHAWK TMS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRYER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, DCSW
Authorized Official - Phone:925-648-2650
Mailing Address - Street 1:PO BOX 2061
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-7061
Mailing Address - Country:US
Mailing Address - Phone:925-648-2650
Mailing Address - Fax:925-648-2530
Practice Address - Street 1:4185 BLACKHAWK PLAZA CIR
Practice Address - Street 2:SUITE 250
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506
Practice Address - Country:US
Practice Address - Phone:925-648-2650
Practice Address - Fax:925-648-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1285000174Medicaid