Healthcare Provider Details

I. General information

NPI: 1437175619
Provider Name (Legal Business Name): PSYCHIATRIC CARE MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 WESTRIDGE DR
KELSEYVILLE CA
95451-8227
US

IV. Provider business mailing address

3455 WESTRIDGE DR
KELSEYVILLE CA
95451-8227
US

V. Phone/Fax

Practice location:
  • Phone: 707-279-2932
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA85774
License Number StateCA

VIII. Authorized Official

Name: DR. OLGA SEGAL
Title or Position: PRESIDENT
Credential: MD
Phone: 707-279-2932