Provider Demographics
NPI:1578685210
Name:SHASTA TREATMENT ASSOCIATES
Entity Type:Organization
Organization Name:SHASTA TREATMENT ASSOCIATES
Other - Org Name:SHASTA TREATMENT CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:GEPHART
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:530-222-4787
Mailing Address - Street 1:11417 PUFFIN WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-1691
Mailing Address - Country:US
Mailing Address - Phone:530-245-9397
Mailing Address - Fax:
Practice Address - Street 1:1175 HARTNELL AVE
Practice Address - Street 2:SUITE C
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2135
Practice Address - Country:US
Practice Address - Phone:530-222-4787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF51591251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health