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
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251S00000X  N AgenciesCommunity/Behavioral Health 
106H00000X  Y193400000X SINGLE SPECIALTY GROUPBehavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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