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General NPI Number Information
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NPI Number | 1760106405
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Entity Type | Organization
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Legal Business Name | CRISIS ALTERNATIVE RESPONSE OF EUREKA
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Dates
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Enumeration Date | 09/27/2022
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 531 K ST
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City | EUREKA
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State | CA
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Zip | 95501-1165
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Country | US
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Telephone | 707-441-4144
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Fax |
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Provider Business Mailing Address
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Address Line | 531 K ST
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City | EUREKA
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State | CA
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Zip | 95501-1165
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Country | US
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Telephone | 707-441-4144
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Fax |
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Authorized Official
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Title or Position | MANAGING MENTAL HEALTH CLINICIAN
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Name | MR. JACOB DANIEL ROSEN
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Credential | LMFT
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Telephone | 707-382-2445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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