Basic Information
| Provider Information | |||||||||
| NPI: | 1497298814 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANTA BARBARA COUNTY DEPARTMENT OF BEHAVIORAL WELLNESS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ARRC-SMJH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 W FOSTER RD | ||||||||
| Address2: | |||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934553620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059346542 | ||||||||
| FaxNumber: | 8059346314 | ||||||||
| Practice Location | |||||||||
| Address1: | 4263 CALIFORNIA BLVD | ||||||||
| Address2: | OUTSIDE PORTABLE ARRC ROOM | ||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934553503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059346542 | ||||||||
| FaxNumber: | 8059346314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2016 | ||||||||
| LastUpdateDate: | 12/03/2016 | ||||||||
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| AuthorizedOfficialLastName: | SUMMERS | ||||||||
| AuthorizedOfficialFirstName: | TAMMY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | QCM COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 8056815450 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SANTA BARBARA COUNTY DEPARTMENT OF BEHAVIORAL WELLNESS | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | LMFT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No ID Information.