NPIMap

Organization Active NPI

Fall Creek Counceling Associates

  • Psychologist
  • Roseville, CA
National Provider Identifier
1083896658
Registry record updated Dec 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY20662 Issued in CA
Legal business name
FALL CREEK COUNCELING ASSOCIATES
Practice address
775 Sunrise Ave
110
Roseville, CA 95661-4523
Phone
(916) 595-7233
NPI assigned
Dec 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Debra L Moore, PH.D.NPI 1265507503
Title
Clinical Director
Phone
(916) 344-0900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X PSY20662 CA Primary

Addresses

Primary practice location

775 Sunrise Ave
110
Roseville, CA 95661-4523

Mailing address

775 Sunrise Ave
110
Roseville, CA 95661-4523
Phone (916) 595-7233

National Provider Directory

National Provider Directory

Locations

775 Sunrise Ave
Ste 110
Roseville, CA 95661
Phone (916) 344-0900

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196812800000",
    "number": "1083896658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "775 SUNRISE AVE",
            "address_2": "110",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956614523",
            "telephone_number": "916-595-7233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 SUNRISE AVE",
            "address_2": "110",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956614523",
            "telephone_number": "916-595-7233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FALL CREEK COUNCELING ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-05",
        "last_updated": "2007-12-05",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "916-344-0900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY20662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.