Healthcare Provider Details

I. General information

NPI: 1902010887
Provider Name (Legal Business Name): COUNTY OF SAN BERNARDINO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18818 HWY 18
APPLE VALLEY CA
92307-0009
US

IV. Provider business mailing address

18818 HWY 18
APPLE VALLEY CA
92307-0009
US

V. Phone/Fax

Practice location:
  • Phone: 760-995-8813
  • Fax: 760-995-8929
Mailing address:
  • Phone: 760-995-8813
  • Fax: 760-995-8929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberZZZ74743Z
License Number StateCA

VIII. Authorized Official

Name: MR. MARK EDWARD THOMAS
Title or Position: MENTAL HEALTH CLINIC SUPERVISOR
Credential: LMFT
Phone: 951-662-3730