Provider Demographics
NPI:1982192084
Name:SIERRA MENTAL WELLNESS GROUP
Entity Type:Organization
Organization Name:SIERRA MENTAL WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECHNICAL SERVICES SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOSTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-783-5207
Mailing Address - Street 1:333 SUNRISE AVE STE 701
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3483
Mailing Address - Country:US
Mailing Address - Phone:916-783-5207
Mailing Address - Fax:
Practice Address - Street 1:2180 B JOHNSON AVENUE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401
Practice Address - Country:US
Practice Address - Phone:805-788-2505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIERRA MENTAL WELLNESS GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health