Provider Demographics
NPI:1336403708
Name:SIERRA STONEGATE
Entity Type:Organization
Organization Name:SIERRA STONEGATE
Other - Org Name:HEALTHY INTERVENTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:VINEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MFT
Authorized Official - Phone:916-475-8590
Mailing Address - Street 1:3657 GOLDENSTAR ST
Mailing Address - Street 2:
Mailing Address - City:PLUMAS LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95961-8746
Mailing Address - Country:US
Mailing Address - Phone:916-475-9586
Mailing Address - Fax:
Practice Address - Street 1:3657 GOLDENSTAR ST
Practice Address - Street 2:
Practice Address - City:PLUMAS LAKE
Practice Address - State:CA
Practice Address - Zip Code:95961-8746
Practice Address - Country:US
Practice Address - Phone:916-475-9586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57436101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty