Provider Demographics
NPI:1417414285
Name:NORTH VALLEY MARRIAGE AND FAMILY COUNSELING, INC.
Entity Type:Organization
Organization Name:NORTH VALLEY MARRIAGE AND FAMILY COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:LOREN
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMFT
Authorized Official - Phone:530-828-8235
Mailing Address - Street 1:2105 FOREST AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7695
Mailing Address - Country:US
Mailing Address - Phone:530-828-8235
Mailing Address - Fax:
Practice Address - Street 1:2105 FOREST AVE STE 120
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7695
Practice Address - Country:US
Practice Address - Phone:530-828-8235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1356533285Medicaid