Healthcare Provider Details

I. General information

NPI: 1366390809
Provider Name (Legal Business Name): IMPERIAL COUNTY BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1699 W MAIN ST STE A
EL CENTRO CA
92243-2235
US

IV. Provider business mailing address

1699 W MAIN ST STE A
EL CENTRO CA
92243-2235
US

V. Phone/Fax

Practice location:
  • Phone: 442-265-7200
  • Fax:
Mailing address:
  • Phone: 442-265-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name: MS. PATRICIA VILLALOBOS
Title or Position: COMMUNITY SERVICE WORKER I
Credential:
Phone: 442-265-7200