Provider Demographics
NPI:1093104325
Name:CAMERON PARK COUNSELING CENTER
Entity Type:Organization
Organization Name:CAMERON PARK COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIETO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:530-677-4404
Mailing Address - Street 1:3294 ROYAL DR STE 13
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8500
Mailing Address - Country:US
Mailing Address - Phone:530-677-4404
Mailing Address - Fax:530-677-4545
Practice Address - Street 1:3294 ROYAL DR STE 13
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8500
Practice Address - Country:US
Practice Address - Phone:530-677-4404
Practice Address - Fax:530-677-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 6138305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service