Basic Information
| Provider Information | |||||||||
| NPI: | 1558378117 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHICO BEHAVIORAL HEALTH, PROFESSIONAL CORPORATION | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3255 ESPLANADE | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959730255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308993150 | ||||||||
| FaxNumber: | 5308993160 | ||||||||
| Practice Location | |||||||||
| Address1: | 3255 ESPLANADE | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959730255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308993150 | ||||||||
| FaxNumber: | 5308993160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 01/14/2011 | ||||||||
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| AuthorizedOfficialLastName: | MAYHEW | ||||||||
| AuthorizedOfficialFirstName: | PAM | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5308993150 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | A069153 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.