Healthcare Provider Details

I. General information

NPI: 1285493163
Provider Name (Legal Business Name): SAN JOAQUIN COUNTY BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S SAN JOAQUIN ST
STOCKTON CA
95202-3206
US

IV. Provider business mailing address

1212 N CALIFORNIA ST
STOCKTON CA
95202-1552
US

V. Phone/Fax

Practice location:
  • Phone: 209-953-5466
  • Fax:
Mailing address:
  • Phone: 209-468-0651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHAHLOH JONES-MITCHELL
Title or Position: MANAGEMENT ANALYST III
Credential:
Phone: 209-468-0651