| Intentional Sustainable Wellness | |
|
4127 Nord Hwy Chico CA 95973-9631 | |
| (612) 723-6417 | |
| Not Available |
| Full Name | Intentional Sustainable Wellness |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 4127 Nord Hwy, Chico, California |
| Authorized Official Name and Position | Lori L Lariviere (FOUNDER, PSYCHIATRY DIRECTOR) |
| Authorized Official Contact | 6127236417 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Intentional Sustainable Wellness 4127 Nord Hwy Chico CA 95973-9631 Ph: (612) 723-6417 | Intentional Sustainable Wellness 4127 Nord Hwy Chico CA 95973-9631 Ph: (612) 723-6417 |
| NPI Number | 1548906803 |
|---|---|
| Provider Enumeration Date | 05/10/2022 |
| Last Update Date | 05/10/2022 |
| Certification Date | 05/10/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548906803 | NPI | - | NPPES |
| 553997 | Other | CA | CALIFORNIA MEDICAL BOARD FICTITIOUS NAME PERMIT (FNP) |
| 4571750 | Other | CA | ENTITY (FILE) NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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