MEDICARE: COUNTY OF SAN LUIS OBISPO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1659776888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF SAN LUIS OBISPO

Provider Business Mailing Address
First Line	:	2180 JOHNSON AVE
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-4513
Country	:	US
Telephone Number	:	805-781-4513
Fax Number	:	805-781-1227

Provider Business Practice Location Address
First Line	:	3500 EL CAMINO REAL
Second Line	:
City	:	ATASCADERO
State	:	CA
Zip	:	93422-4189
Country	:	US
Telephone Number	:	805-781-4513
Fax Number	:

Authorized Official
Title or Position	:	DIVISION MANAGER
Name	:	MS. STARLENE GRABER
Credential	:	PHD, LMFT
Telephone Number	:	805-781-4513

Provider Enumeration Date	:	10/30/2014
Last Update Date	:	10/30/2014

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Directions to “COUNTY OF SAN LUIS OBISPO ” Practice Location

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