O. M. Custer, ED.D.
Individual provider Active NPI Clinical Psychologist · Ione, CA
NPI 1134598295 · NPPES record last updated Sep 18, 2015
Key facts
- NPI
- 1134598295
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY 22981 (CA)
- Practice address
- 14 West Main St
Suite 5
Ione, CA 95640-1415 - Phone
- (209) 642-0724
- NPI assigned
- Sep 18, 2015
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 22981 | CA | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY 22981 | CA | Yes |
Addresses
Primary practice location
14 West Main St
Suite 5
Ione, CA 95640-1415
Mailing address
PO Box 1415
Ione, CA 95640-1415
Phone (209) 642-0724
Other providers in Ione, CA
- CDCR
- Ashlan Chavez
- Leacha M Clark
- Corrections and Rehabilitation-Headquarters
- Corrections and Rehabilitation-Headquarters
- Melissa Derrick
- Pamela Dewitt
- Carlos Guerra Dreiss
- Thomas W Eaton
- First Step Recovery LLC
All providers in Ione, CA · Clinical Psychologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.