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15850 A Dam Road Clearlake CA 95422 | |
(707) 994-6447 | |
(707) 994-1875 |
Full Name | |
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Speciality | Community/behavioral Health |
Location | 15850 A Dam Road, Clearlake, California |
Authorized Official Name and Position | Georgina Lehne (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 7079952920 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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15312 Lakeshore Drive Po Box 969 Clearlake CA 95422 Ph: (707) 995-2920 | 15850 A Dam Road Clearlake CA 95422 Ph: (707) 994-6447 |
NPI Number | 1235464496 |
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Provider Enumeration Date | 10/06/2009 |
Last Update Date | 10/09/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1235464496 | NPI | - | NPPES |
014651850 | Other | CA | COMMUNITY BEHAVIORAL HEALTH |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | 170010BN (California) | Primary |