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General NPI Number Information
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NPI Number | 1205202611
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Entity Type | Organization
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Legal Business Name | MULTI-CULTURAL CENTER FOR PSYCHOTHERAPY, INC.
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 4440 DUCKHORN DR SUITE 400-C
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City | SACRAMENTO
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State | CA
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Zip | 95834-2594
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Country | US
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Telephone | 916-640-9750
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Fax |
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Provider Business Mailing Address
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Address Line | 4440 DUCKHORN DR SUITE 400-C
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City | SACRAMENTO
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State | CA
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Zip | 95834-2594
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Country | US
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Telephone | 916-640-9750
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. AUBREY PIERRE KEYS SR.
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Credential | PSY.D
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Telephone | 916-640-9750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | IMF 66003
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 8644
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License Number State | CA
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