Healthcare Provider Details

I. General information

NPI: 1902268030
Provider Name (Legal Business Name): SIERRA MENTAL WELLNESS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 GLASSON WAY
GRASS VALLEY CA
95945-9561
US

IV. Provider business mailing address

145 GLASSON WAY
GRASS VALLEY CA
95945-5723
US

V. Phone/Fax

Practice location:
  • Phone: 530-470-2425
  • Fax:
Mailing address:
  • Phone: 530-581-4054
  • Fax: 530-265-7027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICOLE VANNEMAN
Title or Position: INTERIM EXECUTIVE DIRECTOR
Credential: LMFT
Phone: 916-783-5207