Healthcare Provider Details

I. General information

NPI: 1285747048
Provider Name (Legal Business Name): HEALTH PSYCHOLOGY SACRAMENTO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 PENNSYLVANIA AVE
FAIR OAKS CA
95628-7413
US

IV. Provider business mailing address

4112 PENNSYLVANIA AVE
FAIR OAKS CA
95628-7413
US

V. Phone/Fax

Practice location:
  • Phone: 916-962-0222
  • Fax: 916-962-7510
Mailing address:
  • Phone: 916-962-0222
  • Fax: 916-962-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberPSY13576
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 13576
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT 37218
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT 47221
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT 50205
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 427621
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN213291
License Number StateCA

VIII. Authorized Official

Name: DR. URSULA R. STEHLE
Title or Position: CLINICAL DIRECTOR
Credential: PHD
Phone: 916-962-0222