Healthcare Provider Details

I. General information

NPI: 1780620609
Provider Name (Legal Business Name): THERON H. KINSEY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9268 MADISON AVE
ORANGEVALE CA
95662-5858
US

IV. Provider business mailing address

9268 MADISON AVE
ORANGEVALE CA
95662-5858
US

V. Phone/Fax

Practice location:
  • Phone: 916-988-1100
  • Fax: 916-988-3995
Mailing address:
  • Phone: 916-988-1100
  • Fax: 916-988-3995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY7235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: