Provider Demographics
NPI:1518271246
Name:PSYCHWEST, CLINICAL AND FORENSIC PSYCHOLOGY
Entity Type:Organization
Organization Name:PSYCHWEST, CLINICAL AND FORENSIC PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:530-751-1122
Mailing Address - Street 1:1445 BUTTE HOUSE RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-2749
Mailing Address - Country:US
Mailing Address - Phone:530-751-1122
Mailing Address - Fax:530-751-1122
Practice Address - Street 1:1445 BUTTE HOUSE RD
Practice Address - Street 2:SUITE F
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-2749
Practice Address - Country:US
Practice Address - Phone:530-751-1122
Practice Address - Fax:530-751-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17789103T00000X, 103TC0700X, 103TF0000X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL177890Medicare PIN