Healthcare Provider Details

I. General information

NPI: 1801930920
Provider Name (Legal Business Name): SOUTH COUNTY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 FREEDOM BLVD SUITE F
WATSONVILLE CA
95076-2780
US

IV. Provider business mailing address

1400 EMELINE AVE
SANTA CRUZ CA
95060-1976
US

V. Phone/Fax

Practice location:
  • Phone: 831-763-8200
  • Fax: 831-454-4663
Mailing address:
  • Phone: 831-454-4971
  • Fax: 831-454-4663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: JESSICA RANDOLPH
Title or Position: DIRECTOR OF ADMINISTRATION
Credential:
Phone: 831-454-4000