Healthcare Provider Details

I. General information

NPI: 1508416322
Provider Name (Legal Business Name): HUMBOLDT COUNTY BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2933 H ST
EUREKA CA
95501-4407
US

IV. Provider business mailing address

720 WOOD ST
EUREKA CA
95501-4413
US

V. Phone/Fax

Practice location:
  • Phone: 707-268-2900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EMI BOTZLER-ROGERS
Title or Position: BH DIRECTOR
Credential: LMFT
Phone: 707-268-2990