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General NPI Number Information
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NPI Number | 1255985248
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Entity Type | Organization
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Legal Business Name | COUNTY OF RIVERSIDE MENTAL HEALTH
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Dates
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Enumeration Date | 07/29/2019
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 3125 MYERS ST BLDG 2
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City | RIVERSIDE
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State | CA
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Zip | 92503-5527
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Country | US
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Telephone | 951-358-4840
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Fax |
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Provider Business Mailing Address
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Address Line | 3060 PANORAMA RD APT 9
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City | RIVERSIDE
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State | CA
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Zip | 92506-1400
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Country | US
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Telephone | 310-722-0574
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH SUPERVISOR
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Name | ISMAEL URBINA
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Credential |
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Telephone | 951-358-4840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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