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17664 Greenridge Rd Hidden Valley Lake CA 95467-8275 | |
(925) 324-6030 | |
Not Available |
Full Name | |
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Speciality | Counselor - Mental Health |
Location | 17664 Greenridge Rd, Hidden Valley Lake, California |
Authorized Official Name and Position | Robert Waldon (CFO) |
Authorized Official Contact | 9253246030 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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17664 Greenridge Rd Hidden Valley Lake CA 95467-8275 Ph: (925) 324-6030 | 17664 Greenridge Rd Hidden Valley Lake CA 95467-8275 Ph: (925) 324-6030 |
NPI Number | 1457123077 |
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Provider Enumeration Date | 10/26/2023 |
Last Update Date | 11/22/2023 |
Certification Date | 11/22/2023 |
Identifier | Type | State | Issuer |
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1457123077 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |