| Mbs Integrative Psychiatry | |
|
214 E Lake St Mount Shasta CA 96067-2331 | |
| (530) 435-5048 | |
| (602) 603-5084 |
| Full Name | Mbs Integrative Psychiatry |
|---|---|
| Speciality | Clinic/Center |
| Location | 214 E Lake St, Mount Shasta, California |
| Authorized Official Name and Position | Nicholas Patrick Brown (CEO) |
| Authorized Official Contact | 5304355048 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mbs Integrative Psychiatry 214 E Lake St Mount Shasta CA 96067-2331 Ph: (530) 435-5048 | Mbs Integrative Psychiatry 214 E Lake St Mount Shasta CA 96067-2331 Ph: (530) 435-5048 |
| NPI Number | 1003422486 |
|---|---|
| Provider Enumeration Date | 09/21/2020 |
| Last Update Date | 04/13/2023 |
| Certification Date | 04/13/2023 |
| Medicare PECOS PAC ID | 8325458276 |
|---|---|
| Medicare Enrollment ID | O20201103002794 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003422486 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | () | Primary |
| 261QM2500X | Clinic/center - Medical Specialty | () | Secondary |
| Provider Name | Beth E Wadman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790859569 PECOS PAC ID: 5597782896 Enrollment ID: I20071228000330 |
| Provider Name | Nicholas Patrick Brown |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275939092 PECOS PAC ID: 7012204522 Enrollment ID: I20201103002858 |
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