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615 Harris St Eureka CA 95503-4447 | |
| (707) 599-7366 | |
| (707) 407-0566 |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 615 Harris St, Eureka, California |
| Authorized Official Name and Position | Roberta Nolan (PRESIDENT/OWNER) |
| Authorized Official Contact | 5303563442 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
615 Harris St Eureka CA 95503-4447 Ph: (707) 599-7366 | 615 Harris St Eureka CA 95503-4447 Ph: (707) 599-7366 |
| NPI Number | 1699446096 |
|---|---|
| Provider Enumeration Date | 09/24/2021 |
| Last Update Date | 06/11/2024 |
| Certification Date | 06/11/2024 |
| Medicare PECOS PAC ID | 4789116195 |
|---|---|
| Medicare Enrollment ID | O20241010000380 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699446096 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Roberta Nolan |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1366575409 PECOS PAC ID: 4486057528 Enrollment ID: I20241010000502 |
| Provider Name | Jelissa Rempojo |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1134883549 PECOS PAC ID: 0345775821 Enrollment ID: I20241120002436 |
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