Healthcare Provider Details

I. General information

NPI: 1902123631
Provider Name (Legal Business Name): MENTAL HEALTH CLIENT ACTION NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 CAYUGA ST
SANTA CRUZ CA
95062-2421
US

IV. Provider business mailing address

1051 CAYUGA ST
SANTA CRUZ CA
95062-2421
US

V. Phone/Fax

Practice location:
  • Phone: 831-469-0462
  • Fax: 831-469-9160
Mailing address:
  • Phone: 831-469-0462
  • Fax: 831-469-9160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: SARAH ELIZABETH LEONARD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 831-469-0462