Healthcare Provider Details

I. General information

NPI: 1396500872
Provider Name (Legal Business Name): GOOD SAMARITAN SHELTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6021 HOLLISTER AVE
GOLETA CA
93117-3217
US

IV. Provider business mailing address

400 W PARK AVE
SANTA MARIA CA
93458-6116
US

V. Phone/Fax

Practice location:
  • Phone: 805-623-5304
  • 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: CHELSEA LAUREL JENSEN
Title or Position: DIRECTOR OF MENTAL HEALTH
Credential: LMFT
Phone: 805-347-3338