Basic Information
Provider Information | |||||||||
NPI: | 1811545429 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NATIVE AMERICAN MENTAL HEALTH SERVICES CORPORATION | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1742 OREGON STREET | ||||||||
Address2: |   | ||||||||
City: | REDDING | ||||||||
State: | CA | ||||||||
PostalCode: | 960011717 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5302267419 | ||||||||
FaxNumber: | 5302249433 | ||||||||
Practice Location | |||||||||
Address1: | 800 W HARRIS ST STE 33 | ||||||||
Address2: |   | ||||||||
City: | EUREKA | ||||||||
State: | CA | ||||||||
PostalCode: | 955033929 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7072967660 | ||||||||
FaxNumber: | 7072967661 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/27/2019 | ||||||||
LastUpdateDate: | 05/03/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | KINNEY | ||||||||
AuthorizedOfficialFirstName: | BENTON | ||||||||
AuthorizedOfficialMiddleName: | C | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER/CFO | ||||||||
AuthorizedOfficialTelephone: | 5302267419 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | PA-C | ||||||||
NPICertificationDate: | 05/03/2021 |
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.