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4535 Missouri Flat Rd Suite 200 C Placerville CA 95667-6846 | |
| (530) 647-1763 | |
| (530) 647-1763 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4535 Missouri Flat Rd, Placerville, California |
| Authorized Official Name and Position | Susan Collette Nelson (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 5306471763 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1091 Pollock Pines CA 95726-1091 Ph: (530) 647-1763 | 4535 Missouri Flat Rd Suite 200 C Placerville CA 95667-6846 Ph: (530) 647-1763 |
| NPI Number | 1568652659 |
|---|---|
| Provider Enumeration Date | 07/26/2007 |
| Last Update Date | 02/23/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568652659 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LCS 21304 (California) | Primary |
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