| |
7000b S Center Dr Clearlake CA 95422-8131 | |
(707) 994-7090 | |
(707) 994-7092 |
Full Name | |
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Speciality | Community/behavioral Health |
Location | 7000b S Center Dr, Clearlake, California |
Authorized Official Name and Position | Elise Jones (BEHAVIORAL HEALTH DIRECTOR) |
Authorized Official Contact | 7072749101 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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P O Box 1024 Lucerne CA 95458 Ph: (707) 274-9101 | 7000b S Center Dr Clearlake CA 95422-8131 Ph: (707) 994-7090 |
NPI Number | 1619039211 |
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Provider Enumeration Date | 12/14/2006 |
Last Update Date | 08/26/2024 |
Certification Date | 08/26/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1619039211 | NPI | - | NPPES |
171712 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (California) | Primary |