Healthcare Provider Details

I. General information

NPI: 1740061977
Provider Name (Legal Business Name): PANACEA THERAPY CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 E 10TH ST STE A
TRACY CA
95376-4063
US

IV. Provider business mailing address

35 E 10TH ST STE A
TRACY CA
95376-4063
US

V. Phone/Fax

Practice location:
  • Phone: 209-666-1003
  • Fax:
Mailing address:
  • Phone: 209-666-1003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHEENA MARIE TURNER-AUGUST
Title or Position: OWNER
Credential: PHD, LMFT
Phone: 209-666-1003