Provider Demographics
NPI:1750770293
Name:CALIFORNIA MENTAL HEALTH
Entity type:Organization
Organization Name:CALIFORNIA MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MCVICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-512-0339
Mailing Address - Street 1:13810 CLIMBING WAY
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9649
Mailing Address - Country:US
Mailing Address - Phone:530-273-1112
Mailing Address - Fax:530-273-1112
Practice Address - Street 1:4736 N VAGEDES AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-0618
Practice Address - Country:US
Practice Address - Phone:559-512-0339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAM MCVICKER, CALIFORNIA MENTAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-22
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14302106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty