Provider Demographics
NPI:1164897039
Name:AMADOR INSTITUTE, INC
Entity Type:Organization
Organization Name:AMADOR INSTITUTE, INC
Other - Org Name:AMADOR INSTITUTE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:925-778-3800
Mailing Address - Street 1:3701 LONE TREE WAY STE 7AND4A
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6038
Mailing Address - Country:US
Mailing Address - Phone:925-778-3800
Mailing Address - Fax:
Practice Address - Street 1:3701 LONE TREE WAY STE 7AND4A
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6038
Practice Address - Country:US
Practice Address - Phone:925-778-3800
Practice Address - Fax:925-778-3915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT22411251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0000007GWMedicaid