1386781425 NPI number — TERRA NOVA COUNSELING

Table of content: (NPI 1386781425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386781425 NPI number — TERRA NOVA COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TERRA NOVA 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:
1386781425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7844 MADISON AVENUE, SUITE #152
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
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-344-0249
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4700 NORTHGATE BLVD
Provider Second Line Business Practice Location Address:
SUITE 122
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95834-1128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-564-0600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOWARD
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
GAYLE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
916-344-0249

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000008462 . This is a "MEDICAL PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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