Healthcare Provider Details

I. General information

NPI: 1326159278
Provider Name (Legal Business Name): KEVIN CARLETON SEYMOUR PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 ATKINS ST
RIDGECREST CA
93555-2501
US

IV. Provider business mailing address

501 ATKINS ST
RIDGECREST CA
93555-2501
US

V. Phone/Fax

Practice location:
  • Phone: 760-446-5515
  • Fax: 760-446-7234
Mailing address:
  • Phone: 760-446-5515
  • Fax: 760-446-7234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY14375
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: