Healthcare Provider Details

I. General information

NPI: 1669654166
Provider Name (Legal Business Name): SB CTY DEPT OF BEHAVIORAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 CARMEN LN
SANTA MARIA CA
93458-7769
US

IV. Provider business mailing address

5385 HOLLISTER AVE BLDG 14
SANTA BARBARA CA
93111-2389
US

V. Phone/Fax

Practice location:
  • Phone: 805-739-8700
  • Fax:
Mailing address:
  • Phone: 805-934-6344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: TAMMY CASIANO
Title or Position: QCM DESIGNEE/COORDINATOR
Credential: LMFT
Phone: 805-325-5905