Healthcare Provider Details

I. General information

NPI: 1598328072
Provider Name (Legal Business Name): COUNTY OF SAN BERNARDINO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

686 E MILL ST
SAN BERNARDINO CA
92408-1610
US

IV. Provider business mailing address

686 E MILL ST
SAN BERNARDINO CA
92415-0647
US

V. Phone/Fax

Practice location:
  • Phone: 909-798-8455
  • Fax: 909-798-8582
Mailing address:
  • Phone: 909-798-8573
  • Fax: 909-798-8582

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. MARK EDWARD THOMAS
Title or Position: MENTAL HEALTH CLINIC SUPERVISOR
Credential: LMFT
Phone: 951-662-3730