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General NPI Number Information
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NPI Number | 1902285208
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Entity Type | Organization
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Legal Business Name | GENUINE DBT LICENSED CLINICAL SOCIAL WORKER INC
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 11/03/2018
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Provider Practice Location Address
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Address Line | 1140 MANGROVE AVE STE D
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City | CHICO
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State | CA
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Zip | 95926
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Country | US
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Telephone | 530-591-5915
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Fax |
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Provider Business Mailing Address
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Address Line | 1017 DOWNING AVE
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City | CHICO
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State | CA
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Zip | 95926-2823
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Country | US
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Telephone | 530-591-5915
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Fax | 888-977-2133
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL COURTER
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Credential | LCSW
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Telephone | 530-809-0066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY26985
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 87407
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW61303
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License Number State | CA
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