| |
7000b S Center Dr Clearlake CA 95422-8131 | |
(707) 994-7090 | |
(707) 994-7092 |
Full Name | |
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Speciality | Clinic/Center |
Location | 7000b S Center Dr, Clearlake, California |
Authorized Official Name and Position | Elise Jones (BEHAVIORAL HEALTH DIRECTOR) |
Authorized Official Contact | 7072749101 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 1024 Lucerne CA 95458-1024 Ph: (707) 274-9101 | 7000b S Center Dr Clearlake CA 95422-8131 Ph: (707) 994-7090 |
NPI Number | 1326252271 |
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Provider Enumeration Date | 05/10/2007 |
Last Update Date | 08/10/2023 |
Certification Date | 08/10/2023 |
Medicare PECOS PAC ID | 2466495429 |
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Medicare Enrollment ID | O20050609001101 |
Identifier | Type | State | Issuer |
---|---|---|---|
1326252271 | NPI | - | NPPES |
1712 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (California) | Primary |
Provider Name | Caroline Little Cribari |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1437185907 PECOS PAC ID: 9830160969 Enrollment ID: I20040803000976 |
Provider Name | Thomas J Lancaster |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1255383998 PECOS PAC ID: 6406807080 Enrollment ID: I20050201001012 |
Provider Name | Martin A Dawson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1073653861 PECOS PAC ID: 8527080498 Enrollment ID: I20051220000990 |
Provider Name | Mindy L Crookham |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1467645382 PECOS PAC ID: 3779673363 Enrollment ID: I20071219000695 |
Provider Name | Thomas J Andrews |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1245393651 PECOS PAC ID: 7618015983 Enrollment ID: I20091130000432 |
Provider Name | Kathleen Timbers-coggin |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1407974827 PECOS PAC ID: 7618949595 Enrollment ID: I20150530000233 |
Provider Name | Socorro Padilla |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1366858623 PECOS PAC ID: 1658634076 Enrollment ID: I20180418001355 |
Provider Name | Darin E Gould |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1376718023 PECOS PAC ID: 0749562635 Enrollment ID: I20201229002913 |