Basic Information
Provider Information | |||||||||
NPI: | 1992298384 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SANTA BARBARA COUNTY DEPARTMENT OF BEHAVIORAL WELLNESS | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | SANTA BARBARA COUNTY MENTAL HEALTH SERVICES | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 315 CAMINO DEL REMEDIO | ||||||||
Address2: |   | ||||||||
City: | SANTA BARBARA | ||||||||
State: | CA | ||||||||
PostalCode: | 931101332 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8056815244 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 315 CAMINO DEL REMEDIO | ||||||||
Address2: | GROUND FLOOR | ||||||||
City: | SANTA BARBARA | ||||||||
State: | CA | ||||||||
PostalCode: | 93110 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8053195248 | ||||||||
FaxNumber: | 8056814269 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/11/2018 | ||||||||
LastUpdateDate: | 06/11/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MENDOZA | ||||||||
AuthorizedOfficialFirstName: | GIZELLE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | QUALITY ASSURANCE COORDINATOR | ||||||||
AuthorizedOfficialTelephone: | 8059346365 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | SANTA BARBARA COUNTY DEPARTMENT OF BEHAVIORAL WELLNESS | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | LCSW | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336I0012X | 55984 | CA | Y |   | Suppliers | Pharmacy | Institutional Pharmacy |
No ID Information.