| N/a | |
|
413 Lincoln Ave Woodland CA 95695-3926 | |
| (530) 661-1666 | |
| (530) 661-1248 |
| Full Name | N/a |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 413 Lincoln Ave, Woodland, California |
| Authorized Official Name and Position | Jack Latow (OWNER) |
| Authorized Official Contact | 5306611666 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| N/a 413 Lincoln Ave Woodland CA 95695-3926 Ph: (530) 661-1666 | N/a 413 Lincoln Ave Woodland CA 95695-3926 Ph: (530) 661-1666 |
| NPI Number | 1154332419 |
|---|---|
| Provider Enumeration Date | 08/11/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154332419 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY08259 (California) | Primary |
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Yolo County Health And Human Services Agency Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 137 N. Cottonwood Street, Suite 1500, Woodland, CA 95695 Phone: 530-666-8630 Fax: 530-666-8633 |