Healthcare Provider Details

I. General information

NPI: 1689813248
Provider Name (Legal Business Name): PHOENIX OF SANTA BARBARA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E MICHELTORENA ST
SANTA BARBARA CA
93101-1905
US

IV. Provider business mailing address

107 E MICHELTORENA ST
SANTA BARBARA CA
93101-1905
US

V. Phone/Fax

Practice location:
  • Phone: 805-965-3434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TALIA BARACH
Title or Position: MENTAL HEALTH COUNSELOR
Credential:
Phone: 818-445-5394