Basic Information
| Provider Information | |||||||||
| NPI: | 1902949910 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | RETTA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AMFT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BROWN | ||||||||
| OtherFirstName: | DONNA | ||||||||
| OtherMiddleName: | RETTA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | AMFT | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1965 LIVE OAK BLVD | ||||||||
| Address2: | |||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308227200 | ||||||||
| FaxNumber: | 5308223296 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 5TH ST | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959015737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307497543 | ||||||||
| FaxNumber: | 5308223296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 08/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LCI02920315 | CA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | APCC5969 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 198585 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.