Healthcare Provider Details

I. General information

NPI: 1336433002
Provider Name (Legal Business Name): SACRAMENTO PSYCHOTHERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2011
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 WATT AVE SUITE 140
SACRAMENTO CA
95821-2667
US

IV. Provider business mailing address

3550 WATT AVE SUITE 140
SACRAMENTO CA
95821-2667
US

V. Phone/Fax

Practice location:
  • Phone: 916-339-7443
  • Fax: 916-359-0737
Mailing address:
  • Phone: 916-339-7443
  • Fax: 916-359-0737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 165
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 48044
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. D CHADWICK THOMPSON
Title or Position: CEO
Credential: MA
Phone: 916-339-7443