Provider Demographics
NPI:1770753055
Name:NORTHERN CALIFORNIA ABUSE TREATMENT
Entity type:Organization
Organization Name:NORTHERN CALIFORNIA ABUSE TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:530-477-7016
Mailing Address - Street 1:2036 NEVADA CITY HWY # 237
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-7700
Mailing Address - Country:US
Mailing Address - Phone:530-477-7016
Mailing Address - Fax:530-477-5919
Practice Address - Street 1:2059 NEVADA CITY HWY STE 104
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-7708
Practice Address - Country:US
Practice Address - Phone:530-477-7016
Practice Address - Fax:530-477-5919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41740106H00000X
CAMFC 42832106H00000X
CAIMF 49385106H00000X
CAMFC 22869106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty