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General NPI Number Information
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NPI Number | 1972658128
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Entity Type | Organization
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Legal Business Name | COUNTY OF MENDOCINO
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 12/02/2023
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Provider Practice Location Address
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Address Line | 1120 S DORA ST
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City | UKIAH
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State | CA
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Zip | 95482-3919
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Country | US
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Telephone | 707-463-4303
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 S DORA ST
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City | UKIAH
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State | CA
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Zip | 95482-6340
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Country | US
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Telephone | 707-472-2300
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Fax |
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Authorized Official
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Title or Position | BHRS DIRECTOR
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Name | DR. JENINE MILLER
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Credential | PSY.D.
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Telephone | 707-472-2341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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Taxonomy #4
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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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