Healthcare Provider Details

I. General information

NPI: 1730450511
Provider Name (Legal Business Name): LASSEN COUNTY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 HOSPITAL LN
SUSANVILLE CA
96130-4808
US

IV. Provider business mailing address

555 HOSPITAL LN
SUSANVILLE CA
96130-4808
US

V. Phone/Fax

Practice location:
  • Phone: 530-251-8080
  • Fax: 530-251-8070
Mailing address:
  • Phone: 530-251-8080
  • Fax: 530-251-8070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHIELA MCGARVA
Title or Position: MH FISCAL OFFICER
Credential:
Phone: 530-251-8080