=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720589260
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CALIFORNIA MENTAL HEALTH COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2018
-----------------------------------------------------
Last Update Date | 02/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 N AUBURN ST STE 212
-----------------------------------------------------
City | GRASS VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95945-6277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-273-1112
-----------------------------------------------------
Fax | 530-273-1112
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13810 CLIMBING WAY
-----------------------------------------------------
City | NEVADA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95959-9649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-273-1112
-----------------------------------------------------
Fax | 530-273-1112
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. KATHLEEN MCVICKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 530-273-1112
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------