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General NPI Number Information
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NPI Number | 1982923009
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Entity Type | Organization
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Legal Business Name | HUMBOLDT FANILYSERVICECENTER
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Dates
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Enumeration Date | 05/28/2010
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Last Update Date | 05/28/2010
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Provider Practice Location Address
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Address Line | 1802 CALIFORNIA ST
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City | EUREKA
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State | CA
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Zip | 95501-2808
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Country | US
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Telephone | 707-443-7358
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Fax | 707-443-1092
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Provider Business Mailing Address
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Address Line | 1802 CALIFORNIA STREET
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City | EUREKA
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State | CA
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Zip | 95501
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Country | US
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Telephone | 707-443-7358
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Fax | 707-443-1092
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. PAULA ANN NEDELCOFF
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Credential | MFT
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Telephone | 707-443-7358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 30069
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License Number State | CA
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