1770834822 NPI number — PRAVINA LEAH LAL LCSW

Table of content: PRAVINA LEAH LAL LCSW (NPI 1770834822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770834822 NPI number — PRAVINA LEAH LAL LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAL
Provider First Name:
PRAVINA
Provider Middle Name:
LEAH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAL
Provider Other First Name:
PRAVINA
Provider Other Middle Name:
LEAH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PRAVINA L. LAL, LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1770834822
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 ILAHEE LN STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95973-7205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-826-9288
Provider Business Mailing Address Fax Number:
--

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 ILAHEE LN STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-826-9288
Provider Business Practice Location Address Fax Number:
--
Provider Enumeration Date:
09/28/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 36826 , 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)