Healthcare Provider Details

I. General information

NPI: 1104396787
Provider Name (Legal Business Name): PREMIER ASSOCIATES GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3512 COFFEE ROAD SUITE B
BAKERSFIELD CA
93308
US

IV. Provider business mailing address

3512 COFFEE ROAD SUITE B
BAKERSFIELD CA
93308
US

V. Phone/Fax

Practice location:
  • Phone: 661-776-0007
  • Fax: 661-427-4599
Mailing address:
  • Phone: 661-776-0007
  • Fax: 661-427-4599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. MARTIN ALLEN HANSEN
Title or Position: PRESIDENT
Credential:
Phone: 661-776-0007