Provider Demographics
NPI:1912449430
Name:DETWILER PSYCHOLOGY APC
Entity type:Organization
Organization Name:DETWILER PSYCHOLOGY APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DETWILER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-636-9444
Mailing Address - Street 1:471 E TAHQUITZ CANYON WAY
Mailing Address - Street 2:219
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6620
Mailing Address - Country:US
Mailing Address - Phone:619-636-9444
Mailing Address - Fax:
Practice Address - Street 1:471 E TAHQUITZ CANYON WAY
Practice Address - Street 2:219
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6620
Practice Address - Country:US
Practice Address - Phone:619-636-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28289103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty