Basic Information
| Provider Information | |||||||||
| NPI: | 1245482207 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SANTA PAULA BEHAVIORAL HEALTH CLINIC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HEALTH CARE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 S VICTORIA AVE # L4615 | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930090003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056775210 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 333 W HARVARD BLVD | ||||||||
| Address2: | |||||||||
| City: | SANTA PAULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930603225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059334868 | ||||||||
| FaxNumber: | 8059334860 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | MILSTIEN | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF DEPUTY DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8056526058 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | VENTURA COUNTY BEHAVIORAL HEALTH | ||||||||
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| AuthorizedOfficialCredential: | MFT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.