Provider Demographics
NPI:1518178193
Name:EL DORADO COUNTY
Entity Type:Organization
Organization Name:EL DORADO COUNTY
Other - Org Name:EL DORADO COUNTY MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BEHAVIORAL HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:EBRAHIMI-NUYKEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:530-621-6545
Mailing Address - Street 1:768 PLEASANT VALLEY ROAD, SUITE 201
Mailing Address - Street 2:
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619
Mailing Address - Country:US
Mailing Address - Phone:530-621-6290
Mailing Address - Fax:530-622-1293
Practice Address - Street 1:768 PLEASANT VALLEY ROAD, SUITE 201
Practice Address - Street 2:
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619
Practice Address - Country:US
Practice Address - Phone:530-621-6290
Practice Address - Fax:530-622-1293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)