Organization
PSYCHSHIELD CORPORATION
Active
Other names
Psychshield Behavioral Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILEY D SUTTON PH.D. (CEO/PSYCHOTHERAPY PROVIDER)
(562) 595-7102
Entity
Organization
Contact information
Practice address
4000 LONG BEACH BLVD STE 212, LONG BEACH, CA 90807-2617
(562) 595-7102
(562) 595-9112
Mailing address
PO BOX 250, LAKEWOOD, CA 90714-0250
(562) 595-7102
(562) 595-9112
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
PSY 4467
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHD 019 00 N
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
07/17/2007
Last updated
01/16/2009
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