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General NPI Number Information
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NPI Number | 1336928647
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Entity Type | Organization
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Legal Business Name | LASSEN INTERVENTION, LLC
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Dates
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Enumeration Date | 09/26/2023
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 44 N LASSEN ST
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City | SUSANVILLE
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State | CA
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Zip | 96130-3966
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Country | US
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Telephone | 530-310-2755
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 192
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City | SUSANVILLE
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State | CA
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Zip | 96130-0192
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Country | US
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Telephone | 530-310-0169
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER CHARLENE PETERSEN
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Credential |
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Telephone | 530-310-2755
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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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