Provider Demographics
NPI:1447037445
Name:DOMAN & WILSON PSYCHOLOGICAL SERVICE, INC.
Entity type:Organization
Organization Name:DOMAN & WILSON PSYCHOLOGICAL SERVICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO AND CO-FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSIAH
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:DOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:209-400-6059
Mailing Address - Street 1:3457 MCHENRY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1445
Mailing Address - Country:US
Mailing Address - Phone:209-400-6059
Mailing Address - Fax:
Practice Address - Street 1:3457 MCHENRY AVE STE B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1445
Practice Address - Country:US
Practice Address - Phone:209-400-6059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty