Healthcare Provider Details

I. General information

NPI: 1003537887
Provider Name (Legal Business Name): SAMUEL SEBASTIAN ECHEVERRIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CROWN POINT CIR STE 100
GRASS VALLEY CA
95945-9561
US

IV. Provider business mailing address

697 NIVENS LN
NEVADA CITY CA
95959-2221
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-5440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: