Provider Demographics
NPI:1184332637
Name:QUANTUM CLINICAL PSYCHOTHERAPY
Entity type:Organization
Organization Name:QUANTUM CLINICAL PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:530-601-1003
Mailing Address - Street 1:105 E ST STE 2E
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4572
Mailing Address - Country:US
Mailing Address - Phone:530-601-1003
Mailing Address - Fax:
Practice Address - Street 1:105 E ST STE 2E
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4572
Practice Address - Country:US
Practice Address - Phone:530-601-1003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)