| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 16858 Yolo Avenue, Esparto, California |
| Authorized Official Name and Position | Katherine Barrett (BEHAVIORALHEALTH COMPLIANCE OFFICER) |
| Authorized Official Contact | 5306668983 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
137 N. Cottonwood Street Suite 2500 - Admin Woodland CA 95695 Ph: () - | 16858 Yolo Avenue Esparto CA 95627 Ph: (530) 687-4110 |
| NPI Number | 1639384159 |
|---|---|
| Provider Enumeration Date | 05/10/2007 |
| Last Update Date | 04/05/2023 |
| Certification Date | 04/05/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639384159 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |