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NPI Code Detail

MEDICARE: THE PHOENIX OF SANTA BARBARA, INC

MEDICARE: THE PHOENIX OF SANTA BARBARA, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor
3101YP2500XProfessional Counselor
4103T00000XPsychologist
5104100000XSocial Worker
6106H00000XMarriage & Family Therapist
7251B00000XCase Management Agency
8251X00000XSupports Brokerage Agency
9261Q00000XClinic/Center
10261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
11320800000XMental Illness Community Based Residential Treatment Facility
12323P00000XPsychiatric Residential Treatment Facility
13251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1023195146
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE PHOENIX OF SANTA BARBARA, INC
Provider Business Mailing Address
First Line : 107 E MICHELTORENA ST
Second Line :
City : SANTA BARBARA
State : CA
Zip : 93101-1905
Country : US
Telephone Number : 805-965-3434
Fax Number : 805-965-3797
Provider Business Practice Location Address
First Line : 107 E MICHELTORENA ST
Second Line :
City : SANTA BARBARA
State : CA
Zip : 93101-1905
Country : US
Telephone Number : 805-965-3434
Fax Number : 805-965-3797
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MS. AVA POLAN
Credential :
Telephone Number : 805-965-3434
Provider Enumeration Date : 11/01/2006
Last Update Date : 04/20/2018

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