Basic Information
| Provider Information | |||||||||
| NPI: | 1477174555 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUMBOLDT COUNTY BEHAVIORAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 WOOD ST | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955014413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072682990 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1615 HEARTWOOD DRIVE | ||||||||
| Address2: | |||||||||
| City: | MCKINLEYVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072682990 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2020 | ||||||||
| LastUpdateDate: | 04/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | BOTZLER-ROGERS | ||||||||
| AuthorizedOfficialFirstName: | EMI | ||||||||
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| AuthorizedOfficialTitleorPosition: | BEHAVIORAL HEALTH DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7072682990 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMFT | ||||||||
| NPICertificationDate: | 04/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.