NPIMap

Organization Active NPI

Redwood Psychology Center, Inc

Doing business as Russian River Counselors

  • Group Psychotherapy Psychologist
  • Monte Rio, CA
National Provider Identifier
1629196290
Registry record updated Oct 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Group Psychotherapy PsychologistTaxonomy code 103TP2701X
License
110000330 Issued in CA
Legal business name
REDWOOD PSYCHOLOGY CENTER, INC
Doing business as
Russian River Counselors
Practice address
19375 Hwy. 116
Monte Rio, CA 95462
Phone
(707) 865-1200
NPI assigned
Mar 26, 2007
Last updated
Oct 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2022

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

Authorized official

Name
Denise Horner, MFTNPI 1457571978
Title
Executive Director
Phone
(707) 865-1200

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
Group Psychotherapy PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TP2701X 110000330 CA Primary

Addresses

Primary practice location

19375 Hwy. 116
Monte Rio, CA 95462

Mailing address

PO Box 519
Monte Rio, CA 95462
Phone (707) 865-1200

Other names 1

  • Russian River Counselors Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221116001129 CA Part B Supplier - Clinic/Group Practice 2062880487 Receives reassigned benefits from 7 practitioners
Practice locations: Monte Rio, CA

National Provider Directory

National Provider Directory
Tax ID family
Redwood Psychology Center Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665014400000",
    "number": "1629196290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 519",
            "city": "MONTE RIO",
            "state": "CA",
            "postal_code": "95462",
            "telephone_number": "707-865-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19375 HWY. 116",
            "city": "MONTE RIO",
            "state": "CA",
            "postal_code": "95462",
            "telephone_number": "707-865-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDWOOD PSYCHOLOGY CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A",
        "authorized_official_last_name": "HORNER",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "707-865-1200",
        "authorized_official_credential": "MFT"
    },
    "taxonomies": [
        {
            "code": "103TP2701X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "CA",
            "license": "110000330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Russian River Counselors",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Russian River Counselors",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monte Rio, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.