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General NPI Number Information
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NPI Number | 1407230329
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Entity Type | Organization
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Legal Business Name | SIERRA MENTAL WELLNESS GROUP
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Dates
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Enumeration Date | 07/10/2015
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 2975 MCMILLAN AVE STE 164
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-6768
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Country | US
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Telephone | 805-994-9915
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Fax | 805-439-4891
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Provider Business Mailing Address
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Address Line | 2945 MCMILLAN AVENUE, #240
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-6766
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Country | US
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Telephone | 805-994-9915
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Fax | 916-783-9145
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Authorized Official
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Title or Position | INTERIM EXECUTIVE DIRECTOR
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Name | MRS. NICOLE VANNEMAN
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Credential | LMFT
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Telephone | 916-783-5207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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