| NPI | 1881219848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN J PETER Credentialing Manager 530-868-6944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2020-09-17 |