| Community Mental Health Youth Services | |
|
1989 Vincente Dr Bldg A San Luis Obispo CA 93405-0001 | |
| (805) 781-4179 | |
| Not Available |
| Full Name | Community Mental Health Youth Services |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 1989 Vincente Dr, San Luis Obispo, California |
| Authorized Official Name and Position | M. Daisy Ilano (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8057814700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Mental Health Youth Services 2178 Johnson Ave San Luis Obispo CA 93401-4535 Ph: (805) 781-4700 | Community Mental Health Youth Services 1989 Vincente Dr Bldg A San Luis Obispo CA 93405-0001 Ph: (805) 781-4179 |
| NPI Number | 1396803870 |
|---|---|
| Provider Enumeration Date | 12/05/2006 |
| Last Update Date | 04/29/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396803870 | NPI | - | NPPES |
| 4017 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (California) | Primary |
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