1942453378 NPI number — SHASTA TREATMENT ASSOCIATES

Table of content: (NPI 1942453378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942453378 NPI number — SHASTA TREATMENT ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHASTA TREATMENT ASSOCIATES
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:
1942453378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2030 HARTNELL AVE
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
REDDING
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96002-5070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-222-4787
Provider Business Mailing Address Fax Number:
530-222-5128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2030 HARTNELL AVE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96002-5070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-222-4787
Provider Business Practice Location Address Fax Number:
530-222-5128
Provider Enumeration Date:
10/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GEPHART
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
I.
Authorized Official Title or Position:
MARRIAGE AND FAMILY THERAPIST
Authorized Official Telephone Number:
530-222-4787

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFT8315 , 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)





Copyright © 2007-2025 www.npivalidator.com