Healthcare Provider Details

I. General information

NPI: 1164333126
Provider Name (Legal Business Name): MILLER CREEK ELEMENTARY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 NOVA ALBION WAY
SAN RAFAEL CA
94903-3523
US

IV. Provider business mailing address

380 NOVA ALBION WAY
SAN RAFAEL CA
94903-3523
US

V. Phone/Fax

Practice location:
  • Phone: 415-874-7564
  • Fax:
Mailing address:
  • Phone: 415-874-7564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MS. CHERYL JACOBS
Title or Position: MENTAL HEALTH AND BEHAVIORAL COOR
Credential: PPS
Phone: 415-492-3789