Provider Demographics
NPI:1902285208
Name:GENUINE DBT LICENSED CLINICAL SOCIAL WORKER INC
Entity Type:Organization
Organization Name:GENUINE DBT LICENSED CLINICAL SOCIAL WORKER INC
Other - Org Name:GENUINE DBT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COURTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:530-809-0066
Mailing Address - Street 1:1017 DOWNING AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2823
Mailing Address - Country:US
Mailing Address - Phone:530-591-5915
Mailing Address - Fax:888-977-2133
Practice Address - Street 1:1140 MANGROVE AVE STE D
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:530-591-5915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2018-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26985103TC0700X
CALCSW613031041C0700X
CA87407106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA173839Medicare PIN