Healthcare Provider Details

I. General information

NPI: 1073867925
Provider Name (Legal Business Name): SIERRA SUMMIT BEHAVIORAL HEALTH & FAMILY THERAPY A PROFESSIONAL CORPOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 CROWN POINT CIR SUITE 150
GRASS VALLEY CA
95945-9088
US

IV. Provider business mailing address

1315 HAZEL ST
GRIDLEY CA
95948-2409
US

V. Phone/Fax

Practice location:
  • Phone: 530-845-4602
  • Fax:
Mailing address:
  • Phone: 530-845-4602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number49918
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number49918
License Number StateCA

VIII. Authorized Official

Name: MR. TALAL H. ALSALEEM
Title or Position: CEO/ CLINICAL DIRECTOR
Credential: LMFT
Phone: 530-845-4602