| Mhsa-cys Foster Youth Fsp | |
|
620 N Aurora St Stockton CA 95202-2343 | |
| (209) 468-8700 | |
| (209) 468-2399 |
| Full Name | Mhsa-cys Foster Youth Fsp |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 620 N Aurora St, Stockton, California |
| Authorized Official Name and Position | Genevieve Valentine (DIRECTOR, BEHAVIORAL HEALTH SERVICE) |
| Authorized Official Contact | 2094688750 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mhsa-cys Foster Youth Fsp 1212 N California St Stockton CA 95202-1552 Ph: (209) 468-9815 | Mhsa-cys Foster Youth Fsp 620 N Aurora St Stockton CA 95202-2343 Ph: (209) 468-8700 |
| NPI Number | 1104012459 |
|---|---|
| Provider Enumeration Date | 09/20/2007 |
| Last Update Date | 05/10/2024 |
| Certification Date | 05/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104012459 | NPI | - | NPPES |
| 9096 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (California) | Primary |
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