Healthcare Provider Details

I. General information

NPI: 1386758837
Provider Name (Legal Business Name): RIDING HIGH EQUESTRIAN PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11685 LORENSON RD
AUBURN CA
95602-9111
US

IV. Provider business mailing address

11685 LORENSON RD
AUBURN CA
95602-9111
US

V. Phone/Fax

Practice location:
  • Phone: 530-888-8891
  • Fax: 530-888-7899
Mailing address:
  • Phone: 530-888-8891
  • Fax: 530-888-7899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFCC 23590
License Number StateCA

VIII. Authorized Official

Name: MS. HONEY COWAN
Title or Position: DIRECTOR
Credential: RN MFCC DAPA CRS
Phone: 530-888-8891