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General NPI Number Information
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NPI Number | 1255704847
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Entity Type | Organization
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Legal Business Name | CHS COUNSELING CENTER
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Dates
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Enumeration Date | 11/04/2015
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Last Update Date | 11/04/2015
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Provider Practice Location Address
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Address Line | 299 12TH ST SUITE C
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City | MARINA
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State | CA
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Zip | 93933-6003
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Country | US
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Telephone | 831-384-3388
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Fax | 831-384-1308
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Provider Business Mailing Address
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Address Line | PO BOX 1340
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City | MARINA
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State | CA
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Zip | 93933-1340
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Country | US
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Telephone | 831-384-3388
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Fax | 831-384-1308
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. REYES BONILLA
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Credential |
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Telephone | 831-384-3388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MFC#53692
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License Number State | CA
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