Provider Demographics
NPI:1902647670
Name:SIERRA AGAPE COUPLES, FAMILY, AND INDIVIDUAL THERAPY, PROF. CORP.
Entity type:Organization
Organization Name:SIERRA AGAPE COUPLES, FAMILY, AND INDIVIDUAL THERAPY, PROF. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBALL
Authorized Official - Middle Name:CONVERSE
Authorized Official - Last Name:PIER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:530-536-8695
Mailing Address - Street 1:P.O. BOX 1794
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93515-1794
Mailing Address - Country:US
Mailing Address - Phone:530-536-8695
Mailing Address - Fax:
Practice Address - Street 1:64A FOOTHILL RD
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514
Practice Address - Country:US
Practice Address - Phone:530-536-8695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty