Provider Demographics
NPI:1801124482
Name:SIERRA AGAPE CENTER
Entity type:Organization
Organization Name:SIERRA AGAPE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBALL
Authorized Official - Middle Name:CONVERSE
Authorized Official - Last Name:PIER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:530-414-1885
Mailing Address - Street 1:10153 W RIVER ST
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-2392
Mailing Address - Country:US
Mailing Address - Phone:530-414-1885
Mailing Address - Fax:
Practice Address - Street 1:15645 ARCHERY VW
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-1419
Practice Address - Country:US
Practice Address - Phone:530-414-1885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44285251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health