MEDICARE: TRINITY HOLISTIC PSYCHIATRY A PROFESSIONAL NURSING CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1912863523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY HOLISTIC PSYCHIATRY A PROFESSIONAL NURSING CORPORATION

Provider Business Mailing Address
First Line	:	717 K ST STE 425
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-3477
Country	:	US
Telephone Number	:	916-610-9401
Fax Number	:

Provider Business Practice Location Address
First Line	:	717 K ST STE 425
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-3477
Country	:	US
Telephone Number	:	916-610-9401
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGING MEMBER
Name	:	MS. KIMBERLY LEWIS
Credential	:	PMNHP-BC
Telephone Number	:	916-610-9401

Provider Enumeration Date	:	12/27/2025
Last Update Date	:	12/27/2025

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