MEDICARE: IMPERIAL 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1871713792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPERIAL COUNTY BEHAVIORAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	202 N 8TH ST
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-4142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 S WATERMAN AVE RM A2 & A3
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-4142
Country	:	US
Telephone Number	:	760-482-4000
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. LETICIA PLANCARTE-GARCIA
Credential	:	MSW, MPA
Telephone Number	:	442-265-1546

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	12/14/2022

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