| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 100 Surrey Court, Barstow, California |
| Authorized Official Name and Position | Martha Obrien (MFT) |
| Authorized Official Contact | 8185158215 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 579 Barstow CA 92312-0579 Ph: (760) 957-7819 | 100 Surrey Court Barstow CA 92311 Ph: (760) 957-7819 |
| NPI Number | 1376028993 |
|---|---|
| Provider Enumeration Date | 09/28/2018 |
| Last Update Date | 07/20/2021 |
| Certification Date | 06/21/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376028993 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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