1285747048 NPI number — HEALTH PSYCHOLOGY SACRAMENTO

Table of content: (NPI 1285747048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285747048 NPI number — HEALTH PSYCHOLOGY SACRAMENTO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH PSYCHOLOGY SACRAMENTO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAIR OAKS THERAPEUTICUM
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285747048
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4112 PENNSYLVANIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIR OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95628-7413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-962-0222
Provider Business Mailing Address Fax Number:
916-962-7510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4112 PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIR OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95628-7413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-962-0222
Provider Business Practice Location Address Fax Number:
916-962-7510
Provider Enumeration Date:
08/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STEHLE
Authorized Official First Name:
URSULA
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
916-962-0222

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY 13576 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: MFT 37218 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: MFT 47221 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: LMFT 50205 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: RN 427621 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: RN213291 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X , with the licence number: PSY13576 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)