Provider Demographics
NPI:1720689565
Name:KINDRED HEART THERAPY GROUP NON-PROFIT ORGANIZATION
Entity Type:Organization
Organization Name:KINDRED HEART THERAPY GROUP NON-PROFIT ORGANIZATION
Other - Org Name:KINDRED HEART THERAPY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:LOVIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKNELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:530-277-2046
Mailing Address - Street 1:PO BOX 2336
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-1946
Mailing Address - Country:US
Mailing Address - Phone:530-277-2046
Mailing Address - Fax:916-969-8373
Practice Address - Street 1:202 PROVIDENCE MINE RD STE 105
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2945
Practice Address - Country:US
Practice Address - Phone:530-277-2046
Practice Address - Fax:916-969-8373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty