Basic Information
| Provider Information | |||||||||
| NPI: | 1780929414 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COUNTY OF SAN LUIS OBISPO BEHAVIORAL HEALTH | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ATCC, DRUG AND ALCOHOL SERVICES | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2180 JOHNSON AVE | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934014513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057814275 | ||||||||
| FaxNumber: | 8057811405 | ||||||||
| Practice Location | |||||||||
| Address1: | 277 SOUTH ST #T | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057814850 | ||||||||
| FaxNumber: | 8057814866 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2012 | ||||||||
| LastUpdateDate: | 12/06/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KIRKLAND | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
| AuthorizedOfficialMiddleName: | GAYLE | ||||||||
| AuthorizedOfficialTitleorPosition: | CASE MANAGER/PEER REPRESENTATIVE | ||||||||
| AuthorizedOfficialTelephone: | 8057814750 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | CERTIFIED COUNSELOR | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302R00000X | Y | Managed Care Organizations | Health Maintenance Organization |
No ID Information.