Provider Demographics
NPI:1811029754
Name:SIERRA MENTAL WELLNESS GROUP
Entity Type:Organization
Organization Name:SIERRA MENTAL WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:R
Authorized Official - Last Name:KERSCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-783-5207
Mailing Address - Street 1:PO BOX 7322
Mailing Address - Street 2:
Mailing Address - City:TAHOE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:96145-7322
Mailing Address - Country:US
Mailing Address - Phone:530-581-4054
Mailing Address - Fax:530-583-4282
Practice Address - Street 1:2690 LAKE FOREST ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:TAHOE CITY
Practice Address - State:CA
Practice Address - Zip Code:96145
Practice Address - Country:US
Practice Address - Phone:530-581-4054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health