Healthcare Provider Details

I. General information

NPI: 1215522735
Provider Name (Legal Business Name): SKYE FORENSIC MENTAL HEALTH CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 01/05/2023
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 DARNIS CIR
MORGAN HILL CA
95037-3853
US

IV. Provider business mailing address

130 DESCANSO DR UNIT 333
SAN JOSE CA
95134-1867
US

V. Phone/Fax

Practice location:
  • Phone: 408-373-0742
  • Fax: 408-612-8798
Mailing address:
  • Phone: 408-373-0742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NATHANIEL ANTHONY WOODS JR.
Title or Position: COE / CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 408-373-0742