Provider Demographics
NPI:1699229005
Name:CRYDER, CHAD (PHD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:CRYDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7067
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0067
Mailing Address - Country:US
Mailing Address - Phone:209-200-8305
Mailing Address - Fax:209-833-7800
Practice Address - Street 1:5250 CLAREMONT AVE STE 118
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5700
Practice Address - Country:US
Practice Address - Phone:209-200-8305
Practice Address - Fax:209-833-7800
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31305103TC0700X, 103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical