Healthcare Provider Details

I. General information

NPI: 1407914500
Provider Name (Legal Business Name): BRIAN A DAHMEN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 DUDLEY BLVD
MCCLELLAN CA
95652-1012
US

IV. Provider business mailing address

1138 ALICE ST
DAVIS CA
95616-2142
US

V. Phone/Fax

Practice location:
  • Phone: 916-561-7687
  • Fax:
Mailing address:
  • Phone: 530-601-7361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number21210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: