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1415 Victor Ave Ste A Redding CA 96003-4194 | |
| (530) 364-4802 | |
| (530) 745-6053 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 1415 Victor Ave Ste A, Redding, California |
| Authorized Official Name and Position | Elizabeth Lyn Huntington-rosenthal (PRESIDENT) |
| Authorized Official Contact | 5303644802 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1415 Victor Ave Ste A Redding CA 96003-4194 Ph: (530) 364-4802 | 1415 Victor Ave Ste A Redding CA 96003-4194 Ph: (530) 364-4802 |
| NPI Number | 1447091210 |
|---|---|
| Provider Enumeration Date | 06/04/2024 |
| Last Update Date | 11/21/2024 |
| Certification Date | 11/21/2024 |
| Medicare PECOS PAC ID | 6901332303 |
|---|---|
| Medicare Enrollment ID | O20241209003173 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447091210 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Elizabeth Lyn Huntington Rosenthal |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1972112522 PECOS PAC ID: 7719413111 Enrollment ID: I20241209003265 |
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