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General NPI Number Information
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NPI Number | 1043030174
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Entity Type | Organization
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Legal Business Name | SEA GLASS THERAPY AND WELLNESS LLC
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Dates
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Enumeration Date | 10/14/2024
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 3359 PENZANCE AVE
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City | CHICO
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State | CA
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Zip | 95973-9683
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Country | US
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Telephone | 405-451-5330
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Fax |
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Provider Business Mailing Address
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Address Line | 1692 MANGROVE AVE # 137
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City | CHICO
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State | CA
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Zip | 95926-2648
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Country | US
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Telephone | 405-451-5330
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MRS. KAYLYNN ADLER
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Credential | LCSW
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Telephone | 901-326-3815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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