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: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 GLASSON WAY
GRASS VALLEY CA
95945-5723
US

IV. Provider business mailing address

925 HIGHLAND POINTE DR STE 130
ROSEVILLE CA
95678-5426
US

V. Phone/Fax

Practice location:
  • Phone: 530-470-2425
  • Fax: 530-265-7027
Mailing address:
  • Phone: 916-783-5207
  • Fax: 916-783-9145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

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