=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376257618
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUMANISTIC CENTER FOR CLINICAL COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2023
-----------------------------------------------------
Last Update Date | 01/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2377 GOLD MEADOW WAY STE 100
-----------------------------------------------------
City | GOLD RIVER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95670-4444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-631-1976
-----------------------------------------------------
Fax | 916-631-1975
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2377 GOLD MEADOW WAY STE 100
-----------------------------------------------------
City | GOLD RIVER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95670-4444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-631-1976
-----------------------------------------------------
Fax | 916-631-1975
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MENTAL HEALTH COUNSELOR
-----------------------------------------------------
Name | MR. NICHOLAS FRANK O'MADDEN
-----------------------------------------------------
Credential | MA, LPCC, NCC
-----------------------------------------------------
Telephone | 916-631-1976
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------