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General NPI Number Information
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NPI Number | 1609091461
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Entity Type | Organization
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Legal Business Name | CHILDREN'S BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 988 MCCOURTNEY RD SUITE 102
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City | GRASS VALLEY
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State | CA
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Zip | 95949-7400
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Country | US
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Telephone | 530-470-2736
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Fax |
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Provider Business Mailing Address
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Address Line | 988 MCCOURTNEY RD SUITE 102
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City | GRASS VALLEY
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State | CA
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Zip | 95949-7400
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Country | US
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Telephone | 530-470-2736
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Fax |
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Authorized Official
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Title or Position | CHILDREN'S PROGRAM MANAGER
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Name | CINDY MORGAN
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Credential | LCSW
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Telephone | 530-470-2736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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