Provider Demographics
NPI:1861851503
Name:WOODS CREEK PSYCHOLOGICAL GROUP, APC
Entity Type:Organization
Organization Name:WOODS CREEK PSYCHOLOGICAL GROUP, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:BELLE
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:209-533-1699
Mailing Address - Street 1:20235 SOMMETTE DR
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-8245
Mailing Address - Country:US
Mailing Address - Phone:209-532-7005
Mailing Address - Fax:209-532-7917
Practice Address - Street 1:103 S FOREST RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-4895
Practice Address - Country:US
Practice Address - Phone:209-533-1699
Practice Address - Fax:209-532-0699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23349103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty