Healthcare Provider Details

I. General information

NPI: 1013853910
Provider Name (Legal Business Name): SISKIYOU WELLNESS COMMUNITY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 VISTA DR
MOUNT SHASTA CA
96067-9778
US

IV. Provider business mailing address

404 N MOUNT SHASTA BLVD # 155
MOUNT SHASTA CA
96067-2232
US

V. Phone/Fax

Practice location:
  • Phone: 530-918-8544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MISS RAMALEE HARNISH
Title or Position: DIRECTOR
Credential: LMFT
Phone: 530-918-8544