Provider Demographics
NPI:1396858668
Name:COUNTY OF MODOC
Entity Type:Organization
Organization Name:COUNTY OF MODOC
Other - Org Name:BEHAVIORAL HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:STOCKTON
Authorized Official - Suffix:
Authorized Official - Credentials:PH D, MSW, BSN
Authorized Official - Phone:530-233-6312
Mailing Address - Street 1:441 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALTURAS
Mailing Address - State:CA
Mailing Address - Zip Code:96101-3457
Mailing Address - Country:US
Mailing Address - Phone:530-233-6312
Mailing Address - Fax:530-233-6339
Practice Address - Street 1:441 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALTURAS
Practice Address - State:CA
Practice Address - Zip Code:96101-3457
Practice Address - Country:US
Practice Address - Phone:530-233-6312
Practice Address - Fax:530-233-6339
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF MODOC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-17
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty