Healthcare Provider Details

I. General information

NPI: 1932664620
Provider Name (Legal Business Name): SAN JOAQUIN COUNTY BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 N. CALIFORIAN ST
STOCKTON CA
95202
US

IV. Provider business mailing address

1212 N. CALIFORIAN ST
STOCKTON CA
95202
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-0102
  • Fax:
Mailing address:
  • Phone: 209-468-0102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHANTAL STENDARDO
Title or Position: CSU PROGRAM MANAGER
Credential:
Phone: 209-468-0102