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General NPI Number Information
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NPI Number | 1093104325
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Entity Type | Organization
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Legal Business Name | CAMERON PARK COUNSELING CENTER
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Dates
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Enumeration Date | 01/09/2015
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Last Update Date | 01/09/2015
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Provider Practice Location Address
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Address Line | 3294 ROYAL DR STE 13
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City | CAMERON PARK
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State | CA
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Zip | 95682-8500
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Country | US
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Telephone | 530-677-4404
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Fax | 530-677-4545
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Provider Business Mailing Address
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Address Line | 3294 ROYAL DR STE 13
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City | CAMERON PARK
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State | CA
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Zip | 95682-8500
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Country | US
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Telephone | 530-677-4404
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Fax | 530-677-4545
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. MARIA NIETO
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Credential | LCSW
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Telephone | 530-677-4404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | PSY 6138
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License Number State | CA
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