Healthcare Provider Details

I. General information

NPI: 1902269459
Provider Name (Legal Business Name): SACRAMENTO INSTITUTE FOR PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 I STREET STE 103
SACRAMENTO CA
95816
US

IV. Provider business mailing address

2830 I STREET STE 103
SACRAMENTO CA
95816
US

V. Phone/Fax

Practice location:
  • Phone: 916-722-7792
  • Fax:
Mailing address:
  • Phone: 916-722-7792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY 23861
License Number StateCA

VIII. Authorized Official

Name: DR. NATHANIEL P MILLS
Title or Position: CLINICAL DIRECTOR
Credential: PH.D.
Phone: 916-722-7792