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NPI Code Detail

MEDICARE: SAN JOAQUIN COUNTY BEHAVIORAL HEALTH SERVICES

MEDICARE: SAN JOAQUIN COUNTY BEHAVIORAL HEALTH SERVICES
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932395282
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAN JOAQUIN COUNTY BEHAVIORAL HEALTH SERVICES
Provider Business Mailing Address
First Line : 1212 N CALIFORNIA ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1552
Country : US
Telephone Number : 209-468-8778
Fax Number : 209-468-2399
Provider Business Practice Location Address
First Line : 4422 N PERSHING AVE
Second Line : SUITE D2, D3, D4, D5 AND D6
City : STOCKTON
State : CA
Zip : 95207-6954
Country : US
Telephone Number : 209-468-8700
Fax Number : 209-468-2399
Authorized Official
Title or Position : DIRECTOR-BEHAVIORAL HEALTH SERVICES
Name : GENEVIEVE VALENTINE
Credential : LMFT
Telephone Number : 209-468-8750
Provider Enumeration Date : 09/20/2007
Last Update Date : 05/03/2024

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Practice Location Address:
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1881716322 — LADA PHASOOK SCHEIDEGGER MFTI
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1356558639 — SAN JOAQUIN COUNTY BEHAVIORAL HEALTH SERVICES
Practice Location Address:
4422 N PERSHING AVE , SUITE D1, D2, D3 AND D4
STOCKTON, CA
95207-6954
Practice Phone: 209-468-8778
Practice Fax: 209-468-2399
1285801902 — ROTHY SOK B.A
Practice Location Address:
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95207-6954
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1538326731 — TIFFANY LOAN DINH RN
Practice Location Address:
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1013177294 — NZONG HER
Practice Location Address:
4422 N PERSHING AVE
STOCKTON, CA
95207-6954
Practice Phone: 209-953-8843
Practice Fax: 209-953-8478

Directions to “SAN JOAQUIN COUNTY BEHAVIORAL HEALTH SERVICES ” Practice Location

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