Provider Demographics
NPI:1447538210
Name:BATH, CHRISTY LEA (PSYD)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LEA
Last Name:BATH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:LEA
Other - Last Name:HEIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:1625 STOCKTON BLVD STE 104
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7098
Practice Address - Country:US
Practice Address - Phone:916-454-6667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28422103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist