| Humboldt Neurohealth Therapeutic Services | |
|
3429 Renner Dr Fortuna CA 95540-3104 | |
| (707) 298-9295 | |
| Not Available |
| Full Name | Humboldt Neurohealth Therapeutic Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 3429 Renner Dr, Fortuna, California |
| Authorized Official Name and Position | Jennifer Brown (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7072969295 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Humboldt Neurohealth Therapeutic Services 3429 Renner Dr Fortuna CA 95540-3104 Ph: (707) 298-9295 | Humboldt Neurohealth Therapeutic Services 3429 Renner Dr Fortuna CA 95540-3104 Ph: (707) 298-9295 |
| NPI Number | 1710459292 |
|---|---|
| Provider Enumeration Date | 12/21/2018 |
| Last Update Date | 12/17/2021 |
| Certification Date | 12/17/2021 |
| Medicare PECOS PAC ID | 6709218589 |
|---|---|
| Medicare Enrollment ID | O20191115002340 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710459292 | NPI | - | NPPES |
| Provider Name | Jennifer Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568709269 PECOS PAC ID: 2668766445 Enrollment ID: I20160803000118 |
| Provider Name | Megan Laurel Shewmaker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174024277 PECOS PAC ID: 0244665024 Enrollment ID: I20200124002070 |
| Provider Name | Larissa Krause |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851884688 PECOS PAC ID: 0042611857 Enrollment ID: I20210630003997 |
| Provider Name | Allison Jane Lundahl |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699354837 PECOS PAC ID: 6103223755 Enrollment ID: I20210923002425 |
| Provider Name | Sonya Michelle Woody |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801438783 PECOS PAC ID: 9638540826 Enrollment ID: I20230126001205 |
| Provider Name | Nina Misch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124405048 PECOS PAC ID: 8729445796 Enrollment ID: I20230606003193 |
| Provider Name | Alyse Jeanne Laverne |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1336762376 PECOS PAC ID: 4688026750 Enrollment ID: I20240115001148 |
| Provider Name | Eric William Gronley |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1659837912 PECOS PAC ID: 2163862921 Enrollment ID: I20240427001894 |
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