Healthcare Provider Details

I. General information

NPI: 1285891549
Provider Name (Legal Business Name): ELLIOTT HASTINGS PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

892 JENSEN LN
WINDSOR CA
95492-9139
US

IV. Provider business mailing address

892 JENSEN LANE
WINDSOR CA
95492
US

V. Phone/Fax

Practice location:
  • Phone: 707-280-9923
  • Fax:
Mailing address:
  • Phone: 707-280-9923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSB94024678
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: