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Organization
SOPER FAMILY PSYCHIATRY MEDICAL GROUP
Active
Organization
SOPER FAMILY PSYCHIATRY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NIKI MOORE (OFFICE MANAGER)
(707) 445-4705
Entity
Organization
Contact information
Practice address
1836 CENTRAL AVE STE A, MCKINLEYVILLE, CA 95519-3667
(707) 445-4705
(707) 445-0581
Mailing address
1836 CENTRAL AVE STE A, MCKINLEYVILLE, CA 95519-3667
(707) 445-4705
(707) 445-0581
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
261QM2500X
Medical Specialty Clinic/Center
Primary
G59380
CA
Other
Enumeration date
07/08/2015
Last updated
10/16/2024
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