Provider Demographics
NPI:1831947175
Name:SIERRA MENTAL WELLNESS GROUP
Entity type:Organization
Organization Name:SIERRA MENTAL WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRISIS CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CASSIDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:NODER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:530-305-4416
Mailing Address - Street 1:1515 FOXRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5958
Mailing Address - Country:US
Mailing Address - Phone:530-305-4416
Mailing Address - Fax:
Practice Address - Street 1:1515 FOXRIDGE CIR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5958
Practice Address - Country:US
Practice Address - Phone:530-305-4416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty