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General NPI Number Information
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NPI Number | 1275662975
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Entity Type | Organization
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Legal Business Name | ECONOMIC OPPORTUNITY COMMISSION OF SAN LUIS OBISPO, INC
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2925 MCMILLAN AVE SUITE 108
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-6765
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Country | US
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Telephone | 805-547-1650
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Fax | 805-544-1995
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Provider Business Mailing Address
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Address Line | 2925 MCMILLAN AVE SUITE 108
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-6765
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Country | US
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Telephone | 805-547-1650
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Fax | 805-544-1995
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. JOSEPH EDWARD HOLIFIELD
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Credential | PH.D.
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Telephone | 805-547-1650
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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 | PSY 19617
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License Number State | CA
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