Healthcare Provider Details

I. General information

NPI: 1982311049
Provider Name (Legal Business Name): IMPERIAL COUNTY BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 HEBER AVE ROOM 105 - 106
HEBER CA
92249-9224
US

IV. Provider business mailing address

202 N 8TH ST FL 2
EL CENTRO CA
92243-2302
US

V. Phone/Fax

Practice location:
  • Phone: 442-265-1546
  • Fax:
Mailing address:
  • Phone: 442-265-1546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LETICIA PLANCARTE- GARCIA
Title or Position: DIRECTOR
Credential: MSW, MPA
Phone: 442-265-1546