Provider Demographics
NPI:1003307877
Name:PACIFIC BEHAVIORAL HEALTH CARE
Entity Type:Organization
Organization Name:PACIFIC BEHAVIORAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCAULIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-687-8021
Mailing Address - Street 1:22 W MISSION ST STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2450
Mailing Address - Country:US
Mailing Address - Phone:805-687-8021
Mailing Address - Fax:805-335-8903
Practice Address - Street 1:22 W MISSION ST STE C
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2450
Practice Address - Country:US
Practice Address - Phone:805-687-8021
Practice Address - Fax:805-335-8903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-28
Last Update Date:2018-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11772103T00000X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP117720Medicaid
CAPSY11772OtherCA. BOARD OF PSYCHOLOGY LICENSE NUMBER
CA504032OtherCA PSYCHOLOGICAL ASSOCIATION NUMBER