Basic Information
| Provider Information | |||||||||
| NPI: | 1417508755 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NATIVE AMERICAN MENTAL HEALTH SERVICES CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NORTH AMERICAN MENTAL HEALTH SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1742 OREGON ST | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960011717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302267419 | ||||||||
| FaxNumber: | 5302249433 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 CHADBOURNE RD STE B | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945349644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074394039 | ||||||||
| FaxNumber: | 7074394035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2019 | ||||||||
| LastUpdateDate: | 06/14/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KINNEY | ||||||||
| AuthorizedOfficialFirstName: | BENTON | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/CFO | ||||||||
| AuthorizedOfficialTelephone: | 5302267419 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PA-C | ||||||||
| NPICertificationDate: | 06/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.