=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396500872
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOOD SAMARITAN SHELTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2024
-----------------------------------------------------
Last Update Date | 02/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6021 HOLLISTER AVE
-----------------------------------------------------
City | GOLETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93117-3217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-623-5304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 W PARK AVE
-----------------------------------------------------
City | SANTA MARIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93458-6116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF MENTAL HEALTH
-----------------------------------------------------
Name | CHELSEA LAUREL JENSEN
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 805-347-3338
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------