Healthcare Provider Details

I. General information

NPI: 1679504542
Provider Name (Legal Business Name): SACRAMENTO COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8853 MOHAMED CIR
ELK GROVE CA
95624-2232
US

IV. Provider business mailing address

8853 MOHAMED CIR
ELK GROVE CA
95624-2232
US

V. Phone/Fax

Practice location:
  • Phone: 408-509-8480
  • Fax:
Mailing address:
  • Phone: 408-509-8480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number40210
License Number StateCA

VIII. Authorized Official

Name: MISS KARA MILLER
Title or Position: LICENSED SR. MENTAL HEALTH COUNSELO
Credential: M.F.T.
Phone: 916-874-5196