Basic Information
| Provider Information | |||||||||
| NPI: | 1578623583 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COUNTY OF BUTTE | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | BUTTE COUNTY DEPT OF BEHAVIORAL HEALTH CHICO ADULT OUTPATIENT | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 560 COHASSET ROAD | ||||||||
| Address2: | SUITE 175 | ||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959262212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308912980 | ||||||||
| FaxNumber: | 5308956548 | ||||||||
| Practice Location | |||||||||
| Address1: | 560 COHASSET ROAD | ||||||||
| Address2: | SUITE 175 | ||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959262212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308912784 | ||||||||
| FaxNumber: | 5308912809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 11/02/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WILNER | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5308793367 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COUNTY OF BUTTE | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MPA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 261QM0855X | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM0850X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.