Provider Demographics
NPI:1548086085
Name:KESAV HEALTH AND WELLNESS LICENSED CLINICAL SOCIAL WORKER PC
Entity type:Organization
Organization Name:KESAV HEALTH AND WELLNESS LICENSED CLINICAL SOCIAL WORKER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:530-632-7894
Mailing Address - Street 1:1007 LIVE OAK BLVD STE B-1
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3454
Mailing Address - Country:US
Mailing Address - Phone:530-713-8845
Mailing Address - Fax:
Practice Address - Street 1:1007 LIVE OAK BLVD STE B-1
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3454
Practice Address - Country:US
Practice Address - Phone:530-633-7734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-30
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty