Provider Demographics
NPI:1750655296
Name:EWING PSYCHOLOGICAL CENTER
Entity Type:Organization
Organization Name:EWING PSYCHOLOGICAL CENTER
Other - Org Name:EWING PSYCHOLOGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:J
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:916-482-6469
Mailing Address - Street 1:100 HOWE AVE
Mailing Address - Street 2:SUITE 155N
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-8202
Mailing Address - Country:US
Mailing Address - Phone:916-482-6463
Mailing Address - Fax:916-482-1327
Practice Address - Street 1:100 HOWE AVE
Practice Address - Street 2:SUITE 155N
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-8202
Practice Address - Country:US
Practice Address - Phone:916-482-6463
Practice Address - Fax:916-482-1327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X
103TB0200X, 103TC0700X, 103TC2200X, 103TF0200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty