=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386178689
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPE FOR HEALTHY FAMILIES COUNSELING CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2017
-----------------------------------------------------
Last Update Date | 11/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8788 ELK GROVE BLVD STE 14
-----------------------------------------------------
City | ELK GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95624-1769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-686-9209
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8788 ELK GROVE BLVD STE 14
-----------------------------------------------------
City | ELK GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95624-1769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-686-9209
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECT
-----------------------------------------------------
Name | REGINA ISABEL K'BURG
-----------------------------------------------------
Credential | PSY
-----------------------------------------------------
Telephone | 916-686-9209
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | MFC 42263
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------