Provider Demographics
NPI:1407991268
Name:SAN BERNARDINO COUNTY DEPT. OF BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:SAN BERNARDINO COUNTY DEPT. OF BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH CLINICIAN III-D
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:GRAHAM
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:909-825-6188
Mailing Address - Street 1:290 N 10TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3052
Mailing Address - Country:US
Mailing Address - Phone:909-825-6188
Mailing Address - Fax:909-872-0652
Practice Address - Street 1:290 N 10TH ST STE 102
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3052
Practice Address - Country:US
Practice Address - Phone:909-825-6188
Practice Address - Fax:909-872-0652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty