Healthcare Provider Details

I. General information

NPI: 1164638334
Provider Name (Legal Business Name): TEHAMA COUNTY HEALTH SERVICES AGENCY MENTAL HEALTH DIVISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 VISTA WAY
RED BLUFF CA
96080-4510
US

IV. Provider business mailing address

PO BOX 400
RED BLUFF CA
96080-0400
US

V. Phone/Fax

Practice location:
  • Phone: 530-527-8491
  • Fax: 530-527-0240
Mailing address:
  • Phone: 530-527-8491
  • Fax: 530-527-0240

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: MS. JAYME S BOTTKE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 530-527-8491