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General NPI Number Information
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NPI Number | 1780929414
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Entity Type | Organization
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Legal Business Name | COUNTY OF SAN LUIS OBISPO BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 12/06/2012
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Provider Practice Location Address
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Address Line | 277 SOUTH ST #T
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401
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Country | US
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Telephone | 805-781-4850
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Fax | 805-781-4866
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Provider Business Mailing Address
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Address Line | 2180 JOHNSON AVE
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-4513
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Country | US
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Telephone | 805-781-4275
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Fax | 805-781-1405
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Authorized Official
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Title or Position | CASE MANAGER/PEER REPRESENTATIVE
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Name | MS. PATRICIA GAYLE KIRKLAND
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Credential | CERTIFIED COUNSELOR
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Telephone | 805-781-4750
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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 |
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License Number State |
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