|
| |
|
100 W 3rd St Cloverdale CA 95425-3204 | |
| (187) 770-0527 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 100 W 3rd St, Cloverdale, California |
| Authorized Official Name and Position | Diana L Stornetta (COMPLIANCE ACCOUNTANT III) |
| Authorized Official Contact | 7075654782 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
100 W 3rd St Cloverdale CA 95425-3204 Ph: (187) 770-0527 | 100 W 3rd St Cloverdale CA 95425-3204 Ph: (187) 770-0527 |
| NPI Number | 1356529663 |
|---|---|
| Provider Enumeration Date | 02/08/2008 |
| Last Update Date | 02/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356529663 | NPI | - | NPPES |
| 49CC1 | Other | CA | CA STATE MEDI-CAL RU |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
Cloverdale Counseling Center, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 216 N Cloverdale Blvd, Cloverdale, CA 95425 Phone: 707-635-9504 | |