Provider Demographics
NPI:1275662975
Name:ECONOMIC OPPORTUNITY COMMISSION OF SAN LUIS OBISPO, INC
Entity Type:Organization
Organization Name:ECONOMIC OPPORTUNITY COMMISSION OF SAN LUIS OBISPO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HOLIFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:805-547-1650
Mailing Address - Street 1:2925 MCMILLAN AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6765
Mailing Address - Country:US
Mailing Address - Phone:805-547-1650
Mailing Address - Fax:805-544-1995
Practice Address - Street 1:2925 MCMILLAN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6765
Practice Address - Country:US
Practice Address - Phone:805-547-1650
Practice Address - Fax:805-544-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19617251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health