Basic Information
| Provider Information | |||||||||
| NPI: | 1275938722 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLUSA COUNTY BEHAVIORAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 162 E CARSON ST STE A | ||||||||
| Address2: | |||||||||
| City: | COLUSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959322880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5304580520 | ||||||||
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| Practice Location | |||||||||
| Address1: | 162 E CARSON ST STE A | ||||||||
| Address2: | |||||||||
| City: | COLUSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959322880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5304580520 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2014 | ||||||||
| LastUpdateDate: | 10/27/2014 | ||||||||
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| AuthorizedOfficialLastName: | MORGAN | ||||||||
| AuthorizedOfficialFirstName: | JAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DEPUTY DIRECTOR OF CLINICAL SERVICE | ||||||||
| AuthorizedOfficialTelephone: | 5304580533 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.