Healthcare Provider Details

I. General information

NPI: 1356531230
Provider Name (Legal Business Name): EL DORADO COUNTY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 PLACERVILLE DR
PLACERVILLE CA
95667-3920
US

IV. Provider business mailing address

344 PLACERVILLE DR
PLACERVILLE CA
95667-3920
US

V. Phone/Fax

Practice location:
  • Phone: 530-621-6290
  • Fax: 530-622-1293
Mailing address:
  • Phone: 530-621-6290
  • Fax: 530-622-1293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSAN E. SIMPKIN
Title or Position: MENTAL HEALTH CLINICIAN
Credential: PSYD
Phone: 530-621-6290