Healthcare Provider Details

I. General information

NPI: 1982901641
Provider Name (Legal Business Name): SAN JOQUIN COUNTY MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 N CALIFORNIA ST
STOCKTON CA
95202-1552
US

IV. Provider business mailing address

4375 ARMADALE WAY
SACRAMENTO CA
95823-4466
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-3370
  • Fax:
Mailing address:
  • Phone: 916-427-5080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES GARRETT
Title or Position: DEPUTY DIRECTOR
Credential:
Phone: 209-468-8894