# SOPER FAMILY PSYCHIATRY MEDICAL GROUP

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699158634
- **Authorized official:** NIKI MOORE (OFFICE MANAGER)
- **Authorized official phone:** (707) 445-4705

## Contact information

- **Practice address:** 1836 CENTRAL AVE STE A, MCKINLEYVILLE, CA 95519-3667
- **Practice address phone:** (707) 445-4705
- **Practice address fax:** (707) 445-0581
- **Mailing address:** 1836 CENTRAL AVE STE A, MCKINLEYVILLE, CA 95519-3667
- **Mailing address phone:** (707) 445-4705
- **Mailing address fax:** (707) 445-0581

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | — | — |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | — |
| 261QM2500X | Medical Specialty Clinic/Center | G59380 | CA | Yes |

## Other

- **Enumeration date:** 07/08/2015
- **Last updated:** 10/16/2024