MEDICARE: COAST AND CANYON PSYCHOLOGICAL SERVICES, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1487500898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COAST AND CANYON PSYCHOLOGICAL SERVICES, PC

Provider Business Mailing Address
First Line	:	2108 N ST STE N
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-5712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2108 N ST STE N
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-5712
Country	:	US
Telephone Number	:	714-397-1646
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST/OWNER
Name	:	SHIVANTI SINGH
Credential	:	PSYD
Telephone Number	:	714-397-1646

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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