Provider Demographics
NPI:1033248885
Name:TAETZSCH,, WILLIAM J (PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:TAETZSCH,
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:MAGALIA
Mailing Address - State:CA
Mailing Address - Zip Code:95954-0640
Mailing Address - Country:US
Mailing Address - Phone:530-876-3174
Mailing Address - Fax:530-876-2183
Practice Address - Street 1:188 COHASSET LN
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2206
Practice Address - Country:US
Practice Address - Phone:530-343-6084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11045103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 11045Medicare UPIN