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General NPI Number Information
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NPI Number | 1871702803
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Entity Type | Organization
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Legal Business Name | NEVADA COUNTY HUMAN SERVICES AGENCY
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 11148 BUTLER RD
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City | GRASS VALLEY
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State | CA
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Zip | 95945-6915
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Country | US
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Telephone | 530-798-8215
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Fax | 530-271-5943
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Provider Business Mailing Address
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Address Line | 11148 BUTLER RD GRASS VALLEY
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City | GRASS VALLEY
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State | CA
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Zip | 95945-6915
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Country | US
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Telephone | 530-798-8215
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Fax | 530-271-5943
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. SUSAN L CLARK
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Credential | MFT #18395
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Telephone | 530-798-8215
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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 | MFC 18395
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License Number State | CA
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