Basic Information
| Provider Information | |||||||||
| NPI: | 1407991268 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN BERNARDINO COUNTY DEPT. OF BEHAVIORAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 290 N 10TH ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | COLTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923243052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098256188 | ||||||||
| FaxNumber: | 9098720652 | ||||||||
| Practice Location | |||||||||
| Address1: | 290 N 10TH ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | COLTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923243052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098256188 | ||||||||
| FaxNumber: | 9098720652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BUCHANAN | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | GRAHAM | ||||||||
| AuthorizedOfficialTitleorPosition: | MENTAL HEALTH CLINICIAN III-D | ||||||||
| AuthorizedOfficialTelephone: | 9098256188 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | L.C.S.W. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 7007 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.