Provider Demographics
NPI:1265647234
Name:SAN JOAQUIN COUNTY BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:SAN JOAQUIN COUNTY BEHAVIORAL HEALTH SERVICES
Other - Org Name:SAN JOAQUIN COUNTY-MH SERVICES LODI CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF BEHAVIORAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:209-468-8887
Mailing Address - Street 1:1212 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1552
Mailing Address - Country:US
Mailing Address - Phone:209-468-8778
Mailing Address - Fax:209-468-2399
Practice Address - Street 1:1209 W TOKAY STREET
Practice Address - Street 2:SUITE 1, 3, 5, 6, 7, 9, 12, 14, AND 16
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3845
Practice Address - Country:US
Practice Address - Phone:209-468-8778
Practice Address - Fax:209-468-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3924Medicaid
CAZZZ89455ZMedicare PIN