Provider Demographics
NPI:1023395662
Name:SHASTA COUNTY
Entity Type:Organization
Organization Name:SHASTA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MENTAL HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:DONNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:EWERT
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:530-245-6750
Mailing Address - Street 1:2640 BRESLAUER
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1021
Mailing Address - Country:US
Mailing Address - Phone:530-245-6750
Mailing Address - Fax:
Practice Address - Street 1:1620/1624 MARKET ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1021
Practice Address - Country:US
Practice Address - Phone:530-245-6750
Practice Address - Fax:530-225-5950
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHASTA COUNTY HEALTH AND HUMAN SERVICES AGENCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health