Provider Demographics
NPI:1811020001
Name:NEVADA COUNTY BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:NEVADA COUNTY BEHAVIORAL HEALTH
Other - Org Name:SIERRA FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:BARON
Authorized Official - Last Name:MCMULLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:530-265-5811
Mailing Address - Street 1:18950 JAYHAWK DR
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95946-9218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 SUTTON WAY
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-4144
Practice Address - Country:US
Practice Address - Phone:530-265-7147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47100251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47100OtherMFTI