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General NPI Number Information
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NPI Number | 1679682363
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Entity Type | Organization
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Legal Business Name | CHW MF
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6615 VALLEY HI DR
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City | SACRAMENTO
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State | CA
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Zip | 95823-4601
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Country | US
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Telephone | 916-681-6300
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Fax | 916-681-6354
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Provider Business Mailing Address
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Address Line | 6615 VALLEY HI DR
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City | SACRAMENTO
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State | CA
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Zip | 95823-4601
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Country | US
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Telephone | 916-681-6300
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Fax | 916-681-6354
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | KAREN CISNEROS
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Credential | MFT
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Telephone | 916-681-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 42397
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License Number State | CA
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