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General NPI Number Information
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NPI Number | 1013049444
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Entity Type | Organization
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Legal Business Name | STANISLAUS COUNTY BEHAVIORAL HEALTH & RECOVERY SERVICES
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1100 KANSAS AVE STE B
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City | MODESTO
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State | CA
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Zip | 95351-1596
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Country | US
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Telephone | 209-558-8884
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Fax | 209-558-8888
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Provider Business Mailing Address
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Address Line | 107 GREENWICH LN.
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City | MODESTO
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State | CA
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Zip | 95351
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Country | US
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Telephone | 209-558-8884
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Fax | 209-558-8888
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Authorized Official
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Title or Position | MENTAL HEALTH CLINICIAN I
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Name | MS. HERMILLE NMN CATZALCO
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Credential | MA
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Telephone | 209-558-8884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 44780
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License Number State | CA
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