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4860 Y St Sacramento CA 95817-2307 | |
| (916) 734-3588 | |
| (916) 452-2739 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 4860 Y St, Sacramento, California |
| Authorized Official Name and Position | William H Mcgowan (CFO) |
| Authorized Official Contact | 9167349129 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4900 Broadway Suite 2600 Sacramento CA 95820-1532 Ph: (916) 734-9200 | 4860 Y St Sacramento CA 95817-2307 Ph: (916) 734-3588 |
| NPI Number | 1295717551 |
|---|---|
| Provider Enumeration Date | 11/14/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295717551 | NPI | - | NPPES |
| GPS000040 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
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