Healthcare Provider Details

I. General information

NPI: 1881464022
Provider Name (Legal Business Name): SAN JOAQUIN COUNTY BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/12/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N AURORA ST STE 305&306
STOCKTON CA
95202-2343
US

IV. Provider business mailing address

1414 N CALIFORNIA ST
STOCKTON CA
95202-1515
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-2385
  • Fax:
Mailing address:
  • Phone: 209-468-2385
  • Fax: 209-468-8024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GENEVIEVE VALENTINE
Title or Position: DEPUTY DIRECTOR BEHAVIORAL HEALTH
Credential: LMFT
Phone: 209-468-8887