Provider Demographics
NPI:1023747326
Name:SIERRA CENTER FOR WELLESS SACRAMENTO A PSYCHOLOGIAL CORPORATION
Entity type:Organization
Organization Name:SIERRA CENTER FOR WELLESS SACRAMENTO A PSYCHOLOGIAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTON
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:916-794-2051
Mailing Address - Street 1:1215 LA SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-3049
Mailing Address - Country:US
Mailing Address - Phone:916-850-9472
Mailing Address - Fax:
Practice Address - Street 1:701 UNIVERSITY AVE STE 225
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6756
Practice Address - Country:US
Practice Address - Phone:916-794-2051
Practice Address - Fax:916-794-2051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty