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1909 Lacey St Bakersfield CA 93304-5917 | |
| (805) 561-8914 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 1909 Lacey St, Bakersfield, California |
| Authorized Official Name and Position | Hopraya Stidom (CEO) |
| Authorized Official Contact | 8055618914 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 13143 Bakersfield CA 93389-3143 Ph: (805) 561-8914 | 1909 Lacey St Bakersfield CA 93304-5917 Ph: (805) 561-8914 |
| NPI Number | 1437973880 |
|---|---|
| Provider Enumeration Date | 11/12/2024 |
| Last Update Date | 12/20/2024 |
| Certification Date | 12/20/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437973880 | NPI | - | NPPES |
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