Provider Demographics
NPI:1114134525
Name:MENDOCINO COUNTY MENTAL HEALTH
Entity Type:Organization
Organization Name:MENDOCINO COUNTY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SERVICES ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JEANPIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:707-463-3368
Mailing Address - Street 1:580 WASHO DR
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5154
Mailing Address - Country:US
Mailing Address - Phone:707-468-9109
Mailing Address - Fax:
Practice Address - Street 1:580 WASHO DR
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5154
Practice Address - Country:US
Practice Address - Phone:707-468-9109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA082942OtherBIRTHDATE