Provider Demographics
NPI:1811387160
Name:CALIFORNIA MENTAL HEALTH
Entity Type:Organization
Organization Name:CALIFORNIA MENTAL HEALTH
Other - Org Name:KATHLEEN MCVICKER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
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
Practice Address - Street 2:STE 212
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:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14302106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty