Provider Demographics
NPI:1831279298
Name:PSYCH COUNSELING MEDICAL OFFICE OF SACRAMENTO INC
Entity Type:Organization
Organization Name:PSYCH COUNSELING MEDICAL OFFICE OF SACRAMENTO INC
Other - Org Name:LESLIE HIRSCHAUT MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HIRSCHAUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-202-5282
Mailing Address - Street 1:PO BOX 2118
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650
Mailing Address - Country:US
Mailing Address - Phone:916-202-5282
Mailing Address - Fax:916-660-1646
Practice Address - Street 1:4250 AUBURN BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841
Practice Address - Country:US
Practice Address - Phone:916-489-3336
Practice Address - Fax:916-488-9147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0498112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A498710Medicaid
F66644Medicare UPIN
CA00A498110Medicare ID - Type Unspecified