Basic Information
| Provider Information | |||||||||
| NPI: | 1619093705 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DEL NORTE COUNTY MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 206 WILLIAMS DR | ||||||||
| Address2: | |||||||||
| City: | CRESCENT CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955318301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074647224 | ||||||||
| FaxNumber: | 7074654272 | ||||||||
| Practice Location | |||||||||
| Address1: | 206 WILLIAMS DR | ||||||||
| Address2: | |||||||||
| City: | CRESCENT CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955318301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074647224 | ||||||||
| FaxNumber: | 7074654272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BLATNICK | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7074647224 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DIRECTOR | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | VN119144 | CA | Y | Agencies | Case Management |
No ID Information.