Basic Information
| Provider Information | |||||||||
| NPI: | 1558982389 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLUSA COUNTY BEHAVIORAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 162 E CARSON ST | ||||||||
| Address2: | |||||||||
| City: | COLUSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959322880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5304580520 | ||||||||
| FaxNumber: | 5304587751 | ||||||||
| Practice Location | |||||||||
| Address1: | 162 E CARSON ST STE B | ||||||||
| Address2: | |||||||||
| City: | COLUSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959322880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5304580520 | ||||||||
| FaxNumber: | 5304587751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2020 | ||||||||
| LastUpdateDate: | 08/26/2020 | ||||||||
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| AuthorizedOfficialLastName: | ROONEY | ||||||||
| AuthorizedOfficialFirstName: | TERENCE | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | BEHAVIORAL HEALTH DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5304580520 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
| NPICertificationDate: | 08/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.