Healthcare Provider Details

I. General information

NPI: 1528625209
Provider Name (Legal Business Name): CALIFORNIA BEHAVIORAL & NURSING PROFESSIONALS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 CRESTLINE AVE
FAIR OAKS CA
95628-7103
US

IV. Provider business mailing address

915 HIGHLAND POINTE DR STE 250
ROSEVILLE CA
95678-5421
US

V. Phone/Fax

Practice location:
  • Phone: 916-903-7778
  • Fax:
Mailing address:
  • Phone: 916-281-9003
  • 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 Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. EMEKA EKWURU
Title or Position: GROUP ADMIN
Credential:
Phone: 916-281-9003