Healthcare Provider Details

I. General information

NPI: 1922722636
Provider Name (Legal Business Name): CLUSTER B FAMILY THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 HEARTLAND DR
PLUMAS LAKE CA
95961-9212
US

IV. Provider business mailing address

5325 ELKHORN BLVD # 1078
SACRAMENTO CA
95842-2526
US

V. Phone/Fax

Practice location:
  • Phone: 916-269-3506
  • Fax:
Mailing address:
  • Phone: 916-269-3506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SONYA HOWELL
Title or Position: CEO AND CO-FOUNDER
Credential:
Phone: 916-269-3506