Provider Demographics
NPI:1295306215
Name:PLACER PSYCHOLOGICAL WELLNESS GROUP, INC
Entity type:Organization
Organization Name:PLACER PSYCHOLOGICAL WELLNESS GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CECCHETTINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-767-4637
Mailing Address - Street 1:420 FOLSOM ROAD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 ESTATES DR STE 109
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2300
Practice Address - Country:US
Practice Address - Phone:530-767-4637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty