Healthcare Provider Details

I. General information

NPI: 1518271246
Provider Name (Legal Business Name): PSYCHWEST, CLINICAL AND FORENSIC PSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 BUTTE HOUSE RD SUITE F
YUBA CITY CA
95993-2749
US

IV. Provider business mailing address

1445 BUTTE HOUSE RD SUITE F
YUBA CITY CA
95993-2749
US

V. Phone/Fax

Practice location:
  • Phone: 530-751-1122
  • Fax: 530-751-1122
Mailing address:
  • Phone: 530-751-1122
  • Fax: 530-751-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number17789
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number17789
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number17789
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number17789
License Number StateCA

VIII. Authorized Official

Name: MR. CRAIG EDWARD WEST
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 530-751-1122