Provider Demographics
NPI:1265714125
Name:CANYON, LEWIS L (PSYD)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:L
Last Name:CANYON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19310 PARKVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-3733
Mailing Address - Country:US
Mailing Address - Phone:510-798-0068
Mailing Address - Fax:
Practice Address - Street 1:19310 PARKVIEW RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-3733
Practice Address - Country:US
Practice Address - Phone:510-798-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34739103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical