Basic Information
| Provider Information | |||||||||
| NPI: | 1790806552 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ENCOMPASS COMMUNITY SERVICES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SANTA CRUZ COMMUNITY COUNSELING CENTER INC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 380 ENCINAL STREET | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314691700 | ||||||||
| FaxNumber: | 8314251905 | ||||||||
| Practice Location | |||||||||
| Address1: | 380 ENCINAL STREET | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314691700 | ||||||||
| FaxNumber: | 8314251905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 11/22/2016 | ||||||||
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| AuthorizedOfficialLastName: | MARTINEZ | ||||||||
| AuthorizedOfficialFirstName: | MONICA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8314691700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.