Northstate Mental Wellness Clinic

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

NORTHSTATE MENTAL WELLNESS CLINIC

Practice address

2920 Prospect Park Dr
Rancho Cordova, CA 95670-6036

Phone

(916) 378-3581

NPI assigned

Apr 24, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Regina Isabel K'Burg, PSYDNPI 1952647711

Title

Clinic Director

Phone

(916) 284-8336

Specialties & licenses 1

Addresses

Tax ID family

Northstate Mental Wellness Clinic2 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.

• Northstate Mental Wellness Clinic

  • Community/Behavioral Health Agency
  • Rancho Cordova, CA
  • NPI 1093558363
  NPD tax ID

Locations

Practitioners 1

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

• Regina Isabel K'Burg, PSYD

  • Clinical Psychologist
  • Stockton, CA
  • NPI 1952647711
  NPD Authorized official

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

{
    "created_epoch": "1713916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713916800000",
    "number": "1750137451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 PROSPECT PARK DR",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956706036",
            "telephone_number": "916-378-3581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 PROSPECT PARK DR",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956706036",
            "telephone_number": "916-378-3581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSTATE MENTAL WELLNESS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-24",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A",
        "authorized_official_last_name": "K'BURG",
        "authorized_official_first_name": "REGINA",
        "authorized_official_middle_name": "ISABEL",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "916-284-8336",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Noel, DDS, MPH
• Travis Ehren Noller
• North Valley Specialty Group Inc.
• Northern California Home Health Services
• Northstate Mental Wellness Clinic
• Emma Morgan Norvell, OTD, OTR/L
• Huda Nour
• Leslie O'Neill, LMFT
• Teresita Alviar Oandasan, CRNA
• Obryan Company Inc

• Mental Health Counselor in Rancho Cordova, CA
• Providers in Rancho Cordova, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; 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.