Healthcare Provider Details

I. General information

NPI: 1174743694
Provider Name (Legal Business Name): DIABLO BEHAVIORAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4185 BLACKHAWK PLAZA CIR SUITE 210
DANVILLE CA
94506-4694
US

IV. Provider business mailing address

PO BOX 1613
DANVILLE CA
94526-6613
US

V. Phone/Fax

Practice location:
  • Phone: 925-648-2650
  • Fax: 925-648-2530
Mailing address:
  • Phone: 925-648-4800
  • Fax: 925-648-2530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 14928
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLEP 2801
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 9942
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 41716
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC29074
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC32821
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA104000
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberC32821
License Number StateCA
# 9
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA104000
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 10617
License Number StateCA
# 11
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 2994
License Number StateCA

VIII. Authorized Official

Name: SUSAN SHRYER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 925-648-4800