Basic Information
| Provider Information | |||||||||
| NPI: | 1255985248 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COUNTY OF RIVERSIDE MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3060 PANORAMA RD APT 9 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925061400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107220574 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3125 MYERS ST BLDG 2 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925035527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513584840 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2019 | ||||||||
| LastUpdateDate: | 07/29/2019 | ||||||||
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| AuthorizedOfficialLastName: | URBINA | ||||||||
| AuthorizedOfficialFirstName: | ISMAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MENTAL HEALTH SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 9513584840 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.