Healthcare Provider Details

I. General information

NPI: 1225113111
Provider Name (Legal Business Name): SAN JUAN UNIFIED SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6147 SUTTER AVE
CARMICHAEL CA
95608-2738
US

IV. Provider business mailing address

6147 SUTTER AVE
CARMICHAEL CA
95608-2738
US

V. Phone/Fax

Practice location:
  • Phone: 916-971-7640
  • Fax:
Mailing address:
  • Phone: 916-971-7640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MONIKA HOWARD
Title or Position: PROGRAM SPECIALIST
Credential: LPCC
Phone: 916-979-8017