Basic Information
| Provider Information | |||||||||
| NPI: | 1336221670 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANTA CLARITA VALLEY MENTAL HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25050 PEACHLAND AVE | ||||||||
| Address2: | 203 | ||||||||
| City: | NEWHALL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913212523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612222800 | ||||||||
| FaxNumber: | 6612553428 | ||||||||
| Practice Location | |||||||||
| Address1: | 25050 PEACHLAND AVE | ||||||||
| Address2: | 203 | ||||||||
| City: | NEWHALL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913212523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612222800 | ||||||||
| FaxNumber: | 6612553428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SPEER | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHIATRIC SOCIAL WORKER | ||||||||
| AuthorizedOfficialTelephone: | 6612222800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | L.C.S.W. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | LCS21039 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.