Provider Demographics
NPI:1477760874
Name:CAMERON PARK COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:CAMERON PARK COUNSELING CENTER, INC.
Other - Org Name:CAMERON PARK COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSE-MARIE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:NIETO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:530-677-4404
Mailing Address - Street 1:970 CAMERADO DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-7636
Mailing Address - Country:US
Mailing Address - Phone:530-677-4404
Mailing Address - Fax:530-677-4545
Practice Address - Street 1:970 CAMERADO DR STE 200
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-7636
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:2007-05-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS102191041C0700X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty