Healthcare Provider Details

I. General information

NPI: 1720271166
Provider Name (Legal Business Name): TRANSITIONS MENTAL HEALTH ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CYPRESS AVE
LOMPOC CA
93436-6806
US

IV. Provider business mailing address

PO BOX 15408
SAN LUIS OBISPO CA
93406-5408
US

V. Phone/Fax

Practice location:
  • Phone: 805-865-1940
  • Fax: 805-865-1954
Mailing address:
  • Phone: 805-540-6500
  • Fax: 805-540-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANK S RICCERI
Title or Position: ASSOCIATE DIRECTOR
Credential: BS
Phone: 805-928-0139