Provider Demographics
NPI:1891930301
Name:GENDER HEALTH CENTER
Entity Type:Organization
Organization Name:GENDER HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NYLUND
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PHD
Authorized Official - Phone:916-719-5581
Mailing Address - Street 1:9175 KIEFER BLVD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-5147
Mailing Address - Country:US
Mailing Address - Phone:916-719-5581
Mailing Address - Fax:
Practice Address - Street 1:9175 KIEFER BLVD
Practice Address - Street 2:SUITE 116
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-5147
Practice Address - Country:US
Practice Address - Phone:916-719-5581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS14463251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health