Gregory Elisha Bottum, PSYD
Individual provider Active NPI Clinical Psychologist · Orangevale, CA
NPI 1639101736 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1639101736
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY 6405 (CA)
- Practice address
- 9264 Madison Ave
Orangevale, CA 95662-5858 - Phone
- (916) 797-0695
- NPI assigned
- Jul 7, 2006
- 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 6405 | CA | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY 6405 | CA | Yes |
Addresses
Primary practice location
9264 Madison Ave
Orangevale, CA 95662-5858
Mailing address
PO Box 2803
Granite Bay, CA 95746-2803
Phone (916) 797-0695
Other providers in Orangevale, CA
- Bethesda Senior Care LLC
- Jasmine Rose Blunt
- Esther Laza Bolthausen
- Liliya Borichevskiy
- David Bostanchyan
- William Scott Brady
- Meredith Brandstetter
- Georgia Lyn Brown I
- Jewel Brown
- Michael A Brown
All providers in Orangevale, 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 Jul 8, 2007. 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.