Healthcare Provider Details

I. General information

NPI: 1750655296
Provider Name (Legal Business Name): EWING PSYCHOLOGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOWE AVE SUITE 155N
SACRAMENTO CA
95825-8202
US

IV. Provider business mailing address

100 HOWE AVE SUITE 155N
SACRAMENTO CA
95825-8202
US

V. Phone/Fax

Practice location:
  • Phone: 916-482-6463
  • Fax: 916-482-1327
Mailing address:
  • Phone: 916-482-6463
  • Fax: 916-482-1327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. TROY J. EWING
Title or Position: CEO
Credential: PSY.D.
Phone: 916-482-6469