Provider Demographics
NPI:1942332788
Name:SIERRA MENTAL WELLNESS GROUP
Entity type:Organization
Organization Name:SIERRA MENTAL WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO- EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANNEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:916-783-5207
Mailing Address - Street 1:406 SUNRISE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4144
Mailing Address - Country:US
Mailing Address - Phone:916-783-5207
Mailing Address - Fax:
Practice Address - Street 1:3079 HARRISON AVE STE D
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7976
Practice Address - Country:US
Practice Address - Phone:530-885-0441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health