Healthcare Provider Details

I. General information

NPI: 1003307877
Provider Name (Legal Business Name): PACIFIC BEHAVIORAL HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2018
Last Update Date: 05/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 W MISSION ST STE C
SANTA BARBARA CA
93101-2450
US

IV. Provider business mailing address

22 W MISSION ST STE C
SANTA BARBARA CA
93101-2450
US

V. Phone/Fax

Practice location:
  • Phone: 805-687-8021
  • Fax: 805-335-8903
Mailing address:
  • Phone: 805-687-8021
  • Fax: 805-335-8903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY11772
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY11772
License Number StateCA

VIII. Authorized Official

Name: MS. KARIN MCAULIFF
Title or Position: CFO
Credential:
Phone: 805-687-8021