Provider Demographics
NPI:1871702803
Name:NEVADA COUNTY HUMAN SERVICES AGENCY
Entity type:Organization
Organization Name:NEVADA COUNTY HUMAN SERVICES AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MFT #18395
Authorized Official - Phone:530-798-8215
Mailing Address - Street 1:11148 BUTLER RD
Mailing Address - Street 2:GRASS VALLEY
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-6915
Mailing Address - Country:US
Mailing Address - Phone:530-798-8215
Mailing Address - Fax:530-271-5943
Practice Address - Street 1:11148 BUTLER RD
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-6915
Practice Address - Country:US
Practice Address - Phone:530-798-8215
Practice Address - Fax:530-271-5943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 18395251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health