Healthcare Provider Details

I. General information

NPI: 1487004404
Provider Name (Legal Business Name): KERN COUNTY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 OSWELL ST 119
BAKERSFIELD CA
93306-3172
US

IV. Provider business mailing address

1415 TRUXTUN AVE
BAKERSFIELD CA
93301-5215
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-6750
  • Fax:
Mailing address:
  • Phone: 661-868-6932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: YSIDORA S ACOSTA
Title or Position: OFFICE SERVICES TECHNICIAN
Credential:
Phone: 661-868-6932