Healthcare Provider Details

I. General information

NPI: 1598167462
Provider Name (Legal Business Name): CARYN TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221B S LENORE AVE
WILLITS CA
95490-3632
US

IV. Provider business mailing address

221B S LENORE AVE
WILLITS CA
95490-3632
US

V. Phone/Fax

Practice location:
  • Phone: 707-456-3710
  • Fax:
Mailing address:
  • Phone: 707-456-3859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF78027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: