Healthcare Provider Details

I. General information

NPI: 1659087567
Provider Name (Legal Business Name): COUNTY OF SANTA CLARA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 E SANTA CLARA ST STE 105
SAN JOSE CA
95112-1936
US

IV. Provider business mailing address

828 S BASCOM AVE STE 200
SAN JOSE CA
95128-2600
US

V. Phone/Fax

Practice location:
  • Phone: 408-961-4645
  • Fax:
Mailing address:
  • Phone: 408-885-5770
  • Fax:

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

VIII. Authorized Official

Name: SHERRI TERAO
Title or Position: DIR, BEHAVIORAL HEALTH SVCS
Credential:
Phone: 408-885-5776