Healthcare Provider Details

I. General information

NPI: 1356825541
Provider Name (Legal Business Name): MOMENTUM BEHAVIOR SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 VALLEY AVENUE
TOMALES CA
94971-9497
US

IV. Provider business mailing address

PO BOX 271
TOMALES CA
94971-0271
US

V. Phone/Fax

Practice location:
  • Phone: 217-246-7688
  • Fax:
Mailing address:
  • Phone: 121-724-6768
  • 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: HANNAH FRANZ-MESICK
Title or Position: OWNER/CEO
Credential:
Phone: 707-806-9921