Healthcare Provider Details

I. General information

NPI: 1609659937
Provider Name (Legal Business Name): HEALTHY MINDS COUNSELING CENTER, LICENSED CLINICAL SOCIAL WORKER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 2ND ST STE C
BRENTWOOD CA
94513-2225
US

IV. Provider business mailing address

1120 2ND ST STE C
BRENTWOOD CA
94513-2225
US

V. Phone/Fax

Practice location:
  • Phone: 925-663-8158
  • Fax:
Mailing address:
  • Phone: 925-663-8158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KIRA MONTERREY
Title or Position: CEO
Credential: LCSW
Phone: 925-663-8158