Healthcare Provider Details

I. General information

NPI: 1982923009
Provider Name (Legal Business Name): HUMBOLDT FANILYSERVICECENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 CALIFORNIA ST
EUREKA CA
95501-2808
US

IV. Provider business mailing address

1802 CALIFORNIA STREET
EUREKA CA
95501
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-7358
  • Fax: 707-443-1092
Mailing address:
  • Phone: 707-443-7358
  • Fax: 707-443-1092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number30069
License Number StateCA

VIII. Authorized Official

Name: MS. PAULA ANN NEDELCOFF
Title or Position: DIRECTOR
Credential: MFT
Phone: 707-443-7358