1225293202 NPI number — PINE MEADOW COUNSELING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225293202 NPI number — PINE MEADOW COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINE MEADOW COUNSELING
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:
Provider Other Organization Name Type Code:
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:
1225293202
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7850 WHITE LN # E249
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93309-7698
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-834-7564
Provider Business Mailing Address Fax Number:
661-831-8882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7070 SCHIRRA CT STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93313-2122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-834-7564
Provider Business Practice Location Address Fax Number:
661-831-8882
Provider Enumeration Date:
07/18/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CROUCH
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
RUSSELL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
661-834-7564

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , 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)