MEDICARE: SEXTANT CONSULTING SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1467929901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEXTANT CONSULTING SERVICES, INC.

Provider Business Mailing Address
First Line	:	3435 WILLIAMS RANCH RD
Second Line	:
City	:	WILLITS
State	:	CA
Zip	:	95490-3530
Country	:	US
Telephone Number	:	707-322-3202
Fax Number	:

Provider Business Practice Location Address
First Line	:	3435 WILLIAMS RANCH RD
Second Line	:
City	:	WILLITS
State	:	CA
Zip	:	95490-3530
Country	:	US
Telephone Number	:	707-322-3202
Fax Number	:

Authorized Official
Title or Position	:	C.E.O.
Name	:	LANCE JASON PARKER
Credential	:
Telephone Number	:	707-322-3202

Provider Enumeration Date	:	11/01/2018
Last Update Date	:	11/01/2018

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