Provider Demographics
NPI:1811105018
Name:THERAPY ASSOCIATES
Entity type:Organization
Organization Name:THERAPY ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LORN
Authorized Official - Last Name:BAUDIZZON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:530-241-9276
Mailing Address - Street 1:PO BOX 990073
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-0073
Mailing Address - Country:US
Mailing Address - Phone:530-241-9276
Mailing Address - Fax:530-241-0114
Practice Address - Street 1:1933 MARKET ST
Practice Address - Street 2:SUITE C
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1929
Practice Address - Country:US
Practice Address - Phone:530-241-9276
Practice Address - Fax:530-241-0114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-19
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20583103TC0700X
CALCS172581041C0700X
CAMFC28949106H00000X
CAPSY13532103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ00767ZMedicare ID - Type Unspecified