1295279099 NPI number — FAMILY COUNSELING OF ELK GROVE

Table of content: (NPI 1295279099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295279099 NPI number — FAMILY COUNSELING OF ELK GROVE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY COUNSELING OF ELK GROVE
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:
1295279099
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8920 EMERALD PARK DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
ELK GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95624-2380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-512-5447
Provider Business Mailing Address Fax Number:
916-721-2447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8920 EMERALD PARK DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ELK GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95624-2380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-512-5447
Provider Business Practice Location Address Fax Number:
916-721-2447
Provider Enumeration Date:
12/13/2016

Additional Information

Authorized Official

Authorized Official Last Name:
DAPHNE
Authorized Official First Name:
DAPHNE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
916-512-5447

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  27778 , 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)

  • Identifier: 0001225635 . This is a "MHN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 816846 . This is a "BEACON HEALTH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 600800791 . This is a "MAGELLAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 006-0204718 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 100159241001 . This is a "BLUE SHIELD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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