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122 W Granger Ave Modesto CA 95350-4431 | |
| (209) 544-1500 | |
| (209) 544-1515 |
| Full Name | |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 122 W Granger Ave, Modesto, California |
| Authorized Official Name and Position | Robert Pauly (DIRECTOR OF OUTPATIENT PROGRAM) |
| Authorized Official Contact | 2095441500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
122 W Granger Ave Modesto CA 95350-4431 Ph: (209) 544-1500 | 122 W Granger Ave Modesto CA 95350-4431 Ph: (209) 544-1500 |
| NPI Number | 1396008009 |
|---|---|
| Provider Enumeration Date | 06/18/2012 |
| Last Update Date | 06/18/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396008009 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 500022BP (California) | Primary |
Golden Valley Health Centers Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1130 6th St, Modesto, CA 95354 Phone: 209-576-2845 Fax: 209-384-3966 | |
Golden Valley Health Centers Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1717 Las Vegas St, Modesto, CA 95358 Phone: 209-576-4200 Fax: 209-384-3966 | |