Provider Demographics
NPI:1447720842
Name:COUNTY OF SHASTA
Entity type:Organization
Organization Name:COUNTY OF SHASTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM SUPERVISOR-BRIDGES TO SCHOO
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:530-225-0350
Mailing Address - Street 1:1644 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1513
Mailing Address - Country:US
Mailing Address - Phone:530-225-0350
Mailing Address - Fax:530-225-0108
Practice Address - Street 1:1544 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1513
Practice Address - Country:US
Practice Address - Phone:530-225-0350
Practice Address - Fax:530-225-0108
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SHASTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty