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General NPI Number Information
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NPI Number | 1073867925
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Entity Type | Organization
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Legal Business Name | SIERRA SUMMIT BEHAVIORAL HEALTH & FAMILY THERAPY A PROFESSIONAL CORPOR
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 350 CROWN POINT CIR SUITE 150
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City | GRASS VALLEY
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State | CA
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Zip | 95945-9088
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Country | US
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Telephone | 530-845-4602
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Fax |
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Provider Business Mailing Address
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Address Line | 1315 HAZEL ST
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City | GRIDLEY
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State | CA
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Zip | 95948-2409
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Country | US
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Telephone | 530-845-4602
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Fax |
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Authorized Official
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Title or Position | CEO/ CLINICAL DIRECTOR
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Name | MR. TALAL H. ALSALEEM
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Credential | LMFT
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Telephone | 530-845-4602
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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 | 49918
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License Number State | CA
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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 | 49918
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License Number State | CA
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