Provider Demographics
NPI:1225418171
Name:SIERRA MENTAL WELLNESS GROUP
Entity Type:Organization
Organization Name:SIERRA MENTAL WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS
Authorized Official - Prefix:
Authorized Official - First Name:SIERRA MENTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLNESS GROUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-885-0441
Mailing Address - Street 1:1116 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2819
Mailing Address - Country:US
Mailing Address - Phone:425-736-1931
Mailing Address - Fax:
Practice Address - Street 1:1116 PEACH ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2819
Practice Address - Country:US
Practice Address - Phone:425-736-1931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty