Provider Demographics
NPI:1295504793
Name:QUEER HUMBOLDT
Entity type:Organization
Organization Name:QUEER HUMBOLDT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDERMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-541-3646
Mailing Address - Street 1:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95518-0045
Mailing Address - Country:US
Mailing Address - Phone:707-502-2890
Mailing Address - Fax:
Practice Address - Street 1:1676 I ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-5530
Practice Address - Country:US
Practice Address - Phone:910-541-3646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty