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General NPI Number Information
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NPI Number | 1528277399
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Entity Type | Organization
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Legal Business Name | LAKE COUNTY MENTAL HEALTH
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 20785 NAPA AVE
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City | MIDDLETOWN
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State | CA
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Zip | 95461-9706
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Country | US
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Telephone | 707-987-0199
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Fax |
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Provider Business Mailing Address
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Address Line | 20785 NAPA AVE
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City | MIDDLETOWN
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State | CA
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Zip | 95461-9706
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Country | US
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Telephone | 707-987-0199
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Fax |
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Authorized Official
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Title or Position | CHILDRENS COORDINATOR
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Name | TERENCE ROOONEY
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Credential | MFT
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Telephone | 707-994-7090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 101YM0800X
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License Number State | CA
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