Healthcare Provider Details

I. General information

NPI: 1982549416
Provider Name (Legal Business Name): NORTHERN CALIFORNIA PSYCHOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 SALEM ST STE 210
CHICO CA
95928-5556
US

IV. Provider business mailing address

702 MANGROVE AVE STE 277
CHICO CA
95926-3948
US

V. Phone/Fax

Practice location:
  • Phone: 530-588-9228
  • Fax:
Mailing address:
  • Phone: 530-588-9228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. RUSTY GILMORE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PHD
Phone: 530-588-9228