Provider Demographics
NPI:1902269459
Name:SACRAMENTO INSTITUTE FOR PSYCHOTHERAPY
Entity Type:Organization
Organization Name:SACRAMENTO INSTITUTE FOR PSYCHOTHERAPY
Other - Org Name:SACRAMENTO INSTITUTE FOR PSYCHOTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:916-722-7792
Mailing Address - Street 1:2830 I STREET
Mailing Address - Street 2:STE 103
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816
Mailing Address - Country:US
Mailing Address - Phone:916-722-7792
Mailing Address - Fax:
Practice Address - Street 1:2830 I STREET
Practice Address - Street 2:STE 103
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816
Practice Address - Country:US
Practice Address - Phone:916-722-7792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 23861103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSB 94022177OtherBOARD OF PSYCHOLOGY