Provider Demographics
NPI:1720589260
Name:CALIFORNIA MENTAL HEALTH COUNSELING
Entity Type:Organization
Organization Name:CALIFORNIA MENTAL HEALTH COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCVICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-273-1112
Mailing Address - Street 1:13810 CLIMBING WAY
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9649
Mailing Address - Country:US
Mailing Address - Phone:530-273-1112
Mailing Address - Fax:530-273-1112
Practice Address - Street 1:120 N AUBURN ST STE 212
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-6277
Practice Address - Country:US
Practice Address - Phone:530-273-1112
Practice Address - Fax:530-273-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1467720474Medicaid