Healthcare Provider Details

I. General information

NPI: 1316222102
Provider Name (Legal Business Name): VENTURA COUNTY BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 W VENTURA ST STE 240
FILLMORE CA
93015-1882
US

IV. Provider business mailing address

828 W VENTURA ST STE 240
FILLMORE CA
93015-1882
US

V. Phone/Fax

Practice location:
  • Phone: 805-524-8660
  • Fax: 805-524-8655
Mailing address:
  • Phone: 805-524-8660
  • Fax: 805-524-8655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30930
License Number StateCA

VIII. Authorized Official

Name: MS. LAURA GUERRA
Title or Position: BEHAVIORAL HEALTH CLINICIAN
Credential: MSW
Phone: 805-524-8660