Active NPI
William A Dahlstrom, PSY.D.
- Clinical Psychologist
- San Luis Obispo, CA
National Provider Identifier
1043433212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY25699
- Practice address
- Highway 1 California Men'S Colony
San Luis Obispo, CA 93409-4023 - Phone
- (805) 547-7900
- NPI assigned
- Apr 10, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY25699 | CA | Primary |
Addresses
Primary practice location
Highway 1 California Men'S Colony
San Luis Obispo, CA 93409-4023
Mailing address
PO Box 8101 CMC
San Luis Obispo, CA 93409-0001
Phone (805) 547-7900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY25699 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664409600000",
"number": "1043433212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8101 CMC",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934090001",
"telephone_number": "805-547-7900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "HIGHWAY 1 CALIFORNIA MEN'S COLONY",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934094023",
"telephone_number": "805-547-7900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAHLSTROM",
"first_name": "WILLIAM",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-10",
"last_updated": "2022-09-29",
"certification_date": "2022-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY25699",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Luis Obispo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.