Basic Information
Provider Information | |||||||||
NPI: | 1215193149 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | FAMILY SERVICE AGENCY OF TEHAMA COUNTY | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | FAMILY COUNSELING CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1112 WASHINGTON ST | ||||||||
Address2: |   | ||||||||
City: | RED BLUFF | ||||||||
State: | CA | ||||||||
PostalCode: | 960802749 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5305276702 | ||||||||
FaxNumber: | 5305277658 | ||||||||
Practice Location | |||||||||
Address1: | 1347 GRANT ST | ||||||||
Address2: |   | ||||||||
City: | RED BLUFF | ||||||||
State: | CA | ||||||||
PostalCode: | 960802366 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5305276702 | ||||||||
FaxNumber: | 5305277658 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/30/2008 | ||||||||
LastUpdateDate: | 07/09/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | VASEY | ||||||||
AuthorizedOfficialFirstName: | HILLARY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 5305276702 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MFC | ||||||||
NPICertificationDate: | 07/09/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X |   |   | N |   | Agencies | Community/Behavioral Health |   | 106H00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   |
No ID Information.