Basic Information
| Provider Information | |||||||||
| NPI: | 1609179431 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KERN COUNTY MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5121 STOCKDALE HWY STE 275 | ||||||||
| Address2: | 5121 STOCKDALE HWY SUITE #275 | ||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933092667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618685004 | ||||||||
| FaxNumber: | 6618368834 | ||||||||
| Practice Location | |||||||||
| Address1: | 5121 STOCKDALE HWY STE 275 | ||||||||
| Address2: | 5121 STOCKDALE HWY SUITE #275 | ||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933092667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618685004 | ||||||||
| FaxNumber: | 6618368834 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2010 | ||||||||
| LastUpdateDate: | 12/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | DOROTHY | ||||||||
| AuthorizedOfficialMiddleName: | LOU | ||||||||
| AuthorizedOfficialTitleorPosition: | RECOVERY SPECIALIST II | ||||||||
| AuthorizedOfficialTelephone: | 6618685004 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | CA | N | Agencies | Community/Behavioral Health | 251B00000X | Y | Agencies | Case Management |
No ID Information.