Healthcare Provider Details

I. General information

NPI: 1821668138
Provider Name (Legal Business Name): CHARLES WILLIAM SMITH-SAYER LPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/29/2021
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WOOD ST
EUREKA CA
95501-4413
US

IV. Provider business mailing address

7750 WOODDALE WAY
CITRUS HEIGHTS CA
95610-2637
US

V. Phone/Fax

Practice location:
  • Phone: 707-268-2990
  • Fax:
Mailing address:
  • Phone: 916-997-5036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number37598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: