Basic Information
| Provider Information | |||||||||
| NPI: | 1972619120 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHW CHILDREN'S CENTER SOUTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6615 VALLEY HI DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958234601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166816300 | ||||||||
| FaxNumber: | 9166816354 | ||||||||
| Practice Location | |||||||||
| Address1: | 6615 VALLEY HI DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958234601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166816300 | ||||||||
| FaxNumber: | 9166816354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | KALKAT | ||||||||
| AuthorizedOfficialFirstName: | KARAMJIT | ||||||||
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| AuthorizedOfficialTitleorPosition: | MENTAL HEALTH COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 9166816300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MFT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MFC42658 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.