MEDICARE: PSYCHWEST, CLINICAL AND FORENSIC PSYCHOLOGY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	17789	CA
2	103TF0000X	Family Psychologist	17789	CA
3	103TF0200X	Forensic Psychologist	17789	CA
4	103T00000X	Psychologist	17789	CA

General Provider Information

NPI Number	:	1518271246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHWEST, CLINICAL AND FORENSIC PSYCHOLOGY

Provider Business Mailing Address
First Line	:	1445 BUTTE HOUSE RD
Second Line	:	SUITE F
City	:	YUBA CITY
State	:	CA
Zip	:	95993-2749
Country	:	US
Telephone Number	:	530-751-1122
Fax Number	:	530-751-1122

Provider Business Practice Location Address
First Line	:	1445 BUTTE HOUSE RD
Second Line	:	SUITE F
City	:	YUBA CITY
State	:	CA
Zip	:	95993-2749
Country	:	US
Telephone Number	:	530-751-1122
Fax Number	:	530-751-1122

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	MR. CRAIG EDWARD WEST
Credential	:	PSYD
Telephone Number	:	530-751-1122

Provider Enumeration Date	:	08/05/2010
Last Update Date	:	08/05/2010

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