Healthcare Provider Details

I. General information

NPI: 1437270733
Provider Name (Legal Business Name): SAN JOAQUIN COUNTY BEHAVIOR HEALTH SUBSTANCE ABUSE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 BIRCH CT
GALT CA
95632-8768
US

IV. Provider business mailing address

620 N AURORA ST STE 1
STOCKTON CA
95202-2276
US

V. Phone/Fax

Practice location:
  • Phone: 209-745-4370
  • Fax:
Mailing address:
  • Phone: 209-468-3823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT LEA
Title or Position: DIRECTOR
Credential:
Phone: 209-468-3720