Provider Demographics
NPI:1225293202
Name:PINE MEADOW COUNSELING
Entity Type:Organization
Organization Name:PINE MEADOW COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:CROUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:661-834-7564
Mailing Address - Street 1:7850 WHITE LN # E249
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-7698
Mailing Address - Country:US
Mailing Address - Phone:661-834-7564
Mailing Address - Fax:661-831-8882
Practice Address - Street 1:7070 SCHIRRA CT STE 200
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-2122
Practice Address - Country:US
Practice Address - Phone:661-834-7564
Practice Address - Fax:661-831-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty