Healthcare Provider Details

I. General information

NPI: 1922581537
Provider Name (Legal Business Name): SOLID GROUND COUNSELING AND THERAPY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W CHURCH ST
UKIAH CA
95482-4603
US

IV. Provider business mailing address

1120 W CHURCH ST
UKIAH CA
95482-4603
US

V. Phone/Fax

Practice location:
  • Phone: 512-576-9772
  • Fax:
Mailing address:
  • Phone: 125-576-9772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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

VIII. Authorized Official

Name: SCOTT D. ALTAMIRANO
Title or Position: COUNSELOR/THERAPIST
Credential: LMFT
Phone: 512-576-9772