| Transition Age Youth | |
|
1211 5th St Eureka CA 95501-0636 | |
| (707) 268-2900 | |
| Not Available |
| Full Name | Transition Age Youth |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1211 5th St, Eureka, California |
| Authorized Official Name and Position | Emi Botzler-rogers (BEHAVIORAL HEALTH DIRECTOR) |
| Authorized Official Contact | 7072682990 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Transition Age Youth 720 Wood St Eureka CA 95501-4413 Ph: (707) 268-2990 | Transition Age Youth 1211 5th St Eureka CA 95501-0636 Ph: (707) 268-2900 |
| NPI Number | 1811267917 |
|---|---|
| Provider Enumeration Date | 01/05/2012 |
| Last Update Date | 03/01/2024 |
| Certification Date | 03/01/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811267917 | NPI | - | NPPES |
| 0000012AP | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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