Provider Demographics
NPI:1538528716
Name:PSYCHNP CONSULTANTS, INC
Entity type:Organization
Organization Name:PSYCHNP CONSULTANTS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGOBET
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:916-633-8353
Mailing Address - Street 1:8624 DIAMOND OAK WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1755
Mailing Address - Country:US
Mailing Address - Phone:800-205-6107
Mailing Address - Fax:916-760-4435
Practice Address - Street 1:8624 DIAMOND OAK WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1755
Practice Address - Country:US
Practice Address - Phone:800-205-6107
Practice Address - Fax:916-760-4435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340111AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty