Provider Demographics
NPI:1679682363
Name:CHW MF
Entity Type:Organization
Organization Name:CHW MF
Other - Org Name:CHILDREN'S CENTER SOUTH
Other - Org Type:Other Name
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CISNEROS
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:916-681-6300
Mailing Address - Street 1:6615 VALLEY HI DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-4601
Mailing Address - Country:US
Mailing Address - Phone:916-681-6300
Mailing Address - Fax:916-681-6354
Practice Address - Street 1:6615 VALLEY HI DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-4601
Practice Address - Country:US
Practice Address - Phone:916-681-6300
Practice Address - Fax:916-681-6354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42397106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty