MEDICARE: SAN LUIS OBISPO COUNTY CHILD ABUSE PREVENTION COUNCIL

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	405300000X	Prevention Professional

General Provider Information

NPI Number	:	1801663497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN LUIS OBISPO COUNTY CHILD ABUSE PREVENTION COUNCIL

Provider Business Mailing Address
First Line	:	7343 EL CAMINO REAL # 346
Second Line	:
City	:	ATASCADERO
State	:	CA
Zip	:	93422-4697
Country	:	US
Telephone Number	:	805-466-5404
Fax Number	:

Provider Business Practice Location Address
First Line	:	3480 S HIGUERA ST STE 100
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-7392
Country	:	US
Telephone Number	:	805-466-5404
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FISCAL OFFICER
Name	:	KAROLYN MARIE KINSEY
Credential	:
Telephone Number	:	805-466-5404

Provider Enumeration Date	:	12/05/2023
Last Update Date	:	12/05/2023

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