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General NPI Number Information
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NPI Number | 1336093301
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Entity Type | Organization
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Legal Business Name | BAYSIDE COUNSELING CENTER INC
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Dates
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Enumeration Date | 02/25/2026
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Last Update Date | 02/25/2026
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Provider Practice Location Address
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Address Line | 8303 SIERRA COLLEGE BLVD STE 146
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City | ROSEVILLE
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State | CA
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Zip | 95661-9419
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Country | US
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Telephone | 916-746-7235
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Fax |
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Provider Business Mailing Address
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Address Line | 8211 SIERRA COLLEGE BLVD STE 440
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City | ROSEVILLE
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State | CA
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Zip | 95661-9406
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Country | US
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Telephone | 916-746-7235
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JEREMY JAMES BOURIS
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Credential | LPC
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Telephone | 916-704-1287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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