| Missing Elements | |
|
1717 Yulupa Ave Ste 5 Santa Rosa CA 95405-6201 | |
| (707) 560-1051 | |
| (866) 803-4979 |
| Full Name | Missing Elements |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1717 Yulupa Ave Ste 5, Santa Rosa, California |
| Authorized Official Name and Position | Suze Cribbs (CLINICAL DIRECTOR) |
| Authorized Official Contact | 7075601051 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Missing Elements Po Box 882 Santa Rosa CA 95402-0882 Ph: (707) 560-1051 | Missing Elements 1717 Yulupa Ave Ste 5 Santa Rosa CA 95405-6201 Ph: (707) 560-1051 |
| NPI Number | 1487908620 |
|---|---|
| Provider Enumeration Date | 11/08/2012 |
| Last Update Date | 04/01/2024 |
| Certification Date | 04/01/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487908620 | NPI | - | NPPES |
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