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General NPI Number Information
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NPI Number | 1508913815
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Entity Type | Organization
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Legal Business Name | SAN LUIS OBISPO COUNTY BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1086 E GRAND AVE
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-2505
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Country | US
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Telephone | 805-474-2028
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Fax | 805-474-2025
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Provider Business Mailing Address
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Address Line | 1086 E GRAND AVE
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-2505
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Country | US
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Telephone | 805-474-2028
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Fax | 805-474-2025
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST IV
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Name | MS. DEANA RAE HUDDLESTON
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Credential | MFT
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Telephone | 805-474-2028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | MFC 40675
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License Number State | CA
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