Provider Demographics
NPI:1962224998
Name:SIERRA AGAPE COUPLES, FAMILY, AND INDIVIDUAL THERAPY
Entity type:Organization
Organization Name:SIERRA AGAPE COUPLES, FAMILY, AND INDIVIDUAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBALL
Authorized Official - Middle Name:CONVERSE
Authorized Official - Last Name:PIER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:530-536-8695
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-0005
Mailing Address - Country:US
Mailing Address - Phone:530-536-8695
Mailing Address - Fax:
Practice Address - Street 1:2854 JACKIE CIRCLE
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423
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:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)