| Wellspring Psychology Pc | |
|
409 Alberto Way Ste 5 Los Gatos CA 95032-5407 | |
| (408) 357-4102 | |
| Not Available |
| Full Name | Wellspring Psychology Pc |
|---|---|
| Speciality | Psychologist |
| Location | 409 Alberto Way Ste 5, Los Gatos, California |
| Authorized Official Name and Position | Richard Joshua Maddox (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 4083574102 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellspring Psychology Pc 409 Alberto Way Ste 5 Los Gatos CA 95032-5407 Ph: (408) 357-4102 | Wellspring Psychology Pc 409 Alberto Way Ste 5 Los Gatos CA 95032-5407 Ph: (408) 357-4102 |
| NPI Number | 1710394911 |
|---|---|
| Provider Enumeration Date | 07/20/2014 |
| Last Update Date | 10/02/2015 |
| Medicare PECOS PAC ID | 1658592258 |
|---|---|
| Medicare Enrollment ID | O20141023002614 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710394911 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 25909 (California) | Primary |
| Provider Name | Matthew J Metzger |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003048968 PECOS PAC ID: 6103047709 Enrollment ID: I20150108000604 |
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