Provider Demographics
NPI:1073867925
Name:SIERRA SUMMIT BEHAVIORAL HEALTH & FAMILY THERAPY A PROFESSIONAL CORPOR
Entity Type:Organization
Organization Name:SIERRA SUMMIT BEHAVIORAL HEALTH & FAMILY THERAPY A PROFESSIONAL CORPOR
Other - Org Name:SIERRA SUMMIT BEHAVIORAL HEALTH, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TALAL
Authorized Official - Middle Name:H
Authorized Official - Last Name:ALSALEEM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:530-845-4602
Mailing Address - Street 1:1315 HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:GRIDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95948-2409
Mailing Address - Country:US
Mailing Address - Phone:530-845-4602
Mailing Address - Fax:
Practice Address - Street 1:350 CROWN POINT CIR
Practice Address - Street 2:SUITE 150
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-9088
Practice Address - Country:US
Practice Address - Phone:530-845-4602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49918261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health