Healthcare Provider Details

I. General information

NPI: 1265647234
Provider Name (Legal Business Name): SAN JOAQUIN COUNTY BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 W TOKAY STREET SUITE 1, 3, 5, 7, 12, 14, AND 16
LODI CA
95240-3845
US

IV. Provider business mailing address

1212 N CALIFORNIA ST
STOCKTON CA
95202-1552
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-8700
  • Fax: 209-468-2399
Mailing address:
  • Phone: 209-468-8778
  • Fax: 209-468-2399

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
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GENEVIEVE VALENTINE
Title or Position: DIRECTOR OF BEHAVIORAL HEALTH
Credential: LMFT
Phone: 209-468-8750