Provider Demographics
NPI:1699775411
Name:PSYCH STRATEGIES INC A PSYCHOLOGICAL CORP
Entity type:Organization
Organization Name:PSYCH STRATEGIES INC A PSYCHOLOGICAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:SWEENEY
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-303-3201
Mailing Address - Street 1:1160 N DUTTON AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4600
Mailing Address - Country:US
Mailing Address - Phone:707-303-3201
Mailing Address - Fax:707-526-8310
Practice Address - Street 1:1160 N DUTTON AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4600
Practice Address - Country:US
Practice Address - Phone:707-303-3201
Practice Address - Fax:707-526-8310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ70268ZMedicare UPIN