Provider Demographics
NPI:1083885347
Name:SHASTA TREATMENT CENTER
Entity Type:Organization
Organization Name:SHASTA TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:GEPHART
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:530-221-6237
Mailing Address - Street 1:2030 HARTNELL AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-5070
Mailing Address - Country:US
Mailing Address - Phone:530-221-6237
Mailing Address - Fax:530-222-5128
Practice Address - Street 1:2030 HARTNELL AVE
Practice Address - Street 2:SUITE D
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-5070
Practice Address - Country:US
Practice Address - Phone:530-221-6237
Practice Address - Fax:530-222-5128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT8315106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty