Healthcare Provider Details

I. General information

NPI: 1083982581
Provider Name (Legal Business Name): MINDY JANE TEWS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SCOFIELD AVE
WASCO CA
93280-7515
US

IV. Provider business mailing address

701 SCOFIELD AVE
WASCO CA
93280-7515
US

V. Phone/Fax

Practice location:
  • Phone: 661-758-8400
  • Fax: 661-758-7069
Mailing address:
  • Phone: 661-758-8400
  • Fax: 661-758-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY20387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: