MEDICARE: ALPINE COUNTY BEHAVIORAL HEALTH SERVICES

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
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1568838084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPINE COUNTY BEHAVIORAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	40 DIAMOND VALLEY ROAD
Second Line	:
City	:	MARKLEEVILLE
State	:	CA
Zip	:	96120-9579
Country	:	US
Telephone Number	:	530-694-1816
Fax Number	:	530-694-2387

Provider Business Practice Location Address
First Line	:	367 CREEKSIDE DR.
Second Line	:
City	:	BEAR VALLEY
State	:	CA
Zip	:	95223
Country	:	US
Telephone Number	:	209-753-2831
Fax Number	:	209-753-2471

Authorized Official
Title or Position	:	MENTAL HEALTH DIRECTOR
Name	:	ALISSA R NORSE
Credential	:	M.ED
Telephone Number	:	530-694-1816

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	10/13/2022

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