Basic Information
| Provider Information | |||||||||
| NPI: | 1013115468 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COUNTY OF SAN LUIS OBISPO DRUG AND ALCOHOL SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2945 MCMILLAN AVE | ||||||||
| Address2: | STE. 136 | ||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934016766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057814275 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2945 MCMILLAN AVE | ||||||||
| Address2: | STE. 136 | ||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934016766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057814275 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WARREN | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
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| AuthorizedOfficialTitleorPosition: | SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 8057882055 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 39753 | CA | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 251K00000X | X | Agencies | Public Health or Welfare |
No ID Information.