| Queer Humboldt | |
|
1676 I St Arcata CA 95521-5530 | |
| (910) 541-3646 | |
| Not Available |
| Full Name | Queer Humboldt |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 1676 I St, Arcata, California |
| Authorized Official Name and Position | Tatiana Mcdermond (BUSINESS MANAGER) |
| Authorized Official Contact | 9105413646 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Queer Humboldt Po Box 45 Arcata CA 95518-0045 Ph: (707) 502-2890 | Queer Humboldt 1676 I St Arcata CA 95521-5530 Ph: (910) 541-3646 |
| NPI Number | 1295504793 |
|---|---|
| Provider Enumeration Date | 12/26/2023 |
| Last Update Date | 12/26/2023 |
| Certification Date | 12/26/2023 |
| Medicare PECOS PAC ID | 4587006259 |
|---|---|
| Medicare Enrollment ID | O20240527000178 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295504793 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Aisha Candrian Morton |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1649549403 PECOS PAC ID: 8426590670 Enrollment ID: I20240604001525 |
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