Provider Demographics
NPI:1831397298
Name:SHASTA TREATMENT ASSOCIATES
Entity type:Organization
Organization Name:SHASTA TREATMENT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:GEPHART
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:530-222-4787
Mailing Address - Street 1:1126 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0436
Mailing Address - Country:US
Mailing Address - Phone:530-229-7723
Mailing Address - Fax:
Practice Address - Street 1:1175 HARTNELL AVE
Practice Address - Street 2:SUITE C
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2135
Practice Address - Country:US
Practice Address - Phone:530-222-4787
Practice Address - Fax:530-222-5128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF53101251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health