Healthcare Provider Details

I. General information

NPI: 1780726737
Provider Name (Legal Business Name): NICOLAS FLORES RIOS ACSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

592 RIO LINDO AVE
CHICO CA
95926-1817
US

IV. Provider business mailing address

109 PARMAC RD STE 1
CHICO CA
95926-2294
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-2810
  • Fax: 530-895-6548
Mailing address:
  • Phone: 530-693-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberACSW 19879
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number84075
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberACSW 19879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: