Healthcare Provider Details

I. General information

NPI: 1932230554
Provider Name (Legal Business Name): KOREY ELLEN KEYTON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 BLANCO CIR STE B
SALINAS CA
93901-4451
US

IV. Provider business mailing address

133 HOLWAY DR
SANTA CRUZ CA
95065-1423
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4510
  • Fax:
Mailing address:
  • Phone: 703-517-5270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY22752
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: