Healthcare Provider Details

I. General information

NPI: 1093967994
Provider Name (Legal Business Name): SUSAN JOAN REDFORD MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 LIVE OAK BLVD
YUBA CITY CA
95991-8828
US

IV. Provider business mailing address

1965 LIVE OAK BLVD
YUBA CITY CA
95991-8828
US

V. Phone/Fax

Practice location:
  • Phone: 530-822-7200
  • Fax: 530-822-7108
Mailing address:
  • Phone: 530-822-7200
  • Fax: 530-822-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC1292
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC1849
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC43709
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: