Healthcare Provider Details

I. General information

NPI: 1407657224
Provider Name (Legal Business Name): TREAT MENTAL HEALTH CALIFORNIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 LINCOLN AVE STE 218
SAN JOSE CA
95125-3031
US

IV. Provider business mailing address

2108 N ST # 8989
SACRAMENTO CA
95816-5712
US

V. Phone/Fax

Practice location:
  • Phone: 949-670-9837
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DEREK CISNA
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 949-670-9837