Provider Demographics
NPI:1386889863
Name:TERRA NOVA COUNSELING
Entity type:Organization
Organization Name:TERRA NOVA COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:STROUBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-344-0964
Mailing Address - Street 1:4700 NORTHGATE BLVD STE 122
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1148
Mailing Address - Country:US
Mailing Address - Phone:916-564-0600
Mailing Address - Fax:
Practice Address - Street 1:5750 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7634
Practice Address - Country:US
Practice Address - Phone:916-334-4096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000008462OtherMEDICALL PROVIDER #