Basic Information
| Provider Information | |||||||||
| NPI: | 1235357229 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COUNTY OF SUTTER | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | SYBH (CHILDRENS SYSTEM OF CARE) | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 809 PLUMAS ST | ||||||||
| Address2: | ATTN SYBH (CHILDRENS SYSTEM OF CARE) | ||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959914437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308227478 | ||||||||
| FaxNumber: | 5308227484 | ||||||||
| Practice Location | |||||||||
| Address1: | 809 PLUMAS ST | ||||||||
| Address2: | ATTN SYBH (CHILDRENS SYSTEM OF CARE) | ||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959914437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308227478 | ||||||||
| FaxNumber: | 5308227484 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 08/13/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BINGHAM | ||||||||
| AuthorizedOfficialFirstName: | RICK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT HHS DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5308227327 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COUNTY OF SUTTER | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | LMFT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 5840 | 01 | CA | SHORT-DOYLE MEDI-CAL | OTHER |