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145 N 2nd Ave Ste 10 Oakdale CA 95361-3064 | |
| (209) 523-4573 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 145 N 2nd Ave Ste 10, Oakdale, California |
| Authorized Official Name and Position | Stacey Bronken (QUALITY ASSURANCE SUPERVISOR) |
| Authorized Official Contact | 2095234573 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1400 K St Ste F Modesto CA 95354-1018 Ph: (209) 523-4573 | 145 N 2nd Ave Ste 10 Oakdale CA 95361-3064 Ph: (209) 523-4573 |
| NPI Number | 1770616575 |
|---|---|
| Provider Enumeration Date | 03/13/2007 |
| Last Update Date | 03/19/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770616575 | NPI | - | NPPES |
| 5015 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Wellspring Counseling Ministries, A Project Of Ucp Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 603 W F St, Oakdale, CA 95361 Phone: 209-322-9801 Fax: 209-848-8825 | |
Jeanette Kay Lasater Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 603 W F St, Oakdale, CA 95361 Phone: 209-288-2682 Fax: 209-288-2682 | |