Provider Demographics
NPI:1417074089
Name:MARIPOSA COUNTY BEHAVIORAL HEALTH & RECOVERY
Entity Type:Organization
Organization Name:MARIPOSA COUNTY BEHAVIORAL HEALTH & RECOVERY
Other - Org Name:MARIPOSA COUNTY FOSTER CARE ASO
Other - Org Type:Other Name
Authorized Official - Title/Position:ACCOUNT CLERK III
Authorized Official - Prefix:
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-966-2000
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-0099
Mailing Address - Country:US
Mailing Address - Phone:209-966-2000
Mailing Address - Fax:209-966-8251
Practice Address - Street 1:5362 LEMEE LANE
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-0099
Practice Address - Country:US
Practice Address - Phone:209-966-2000
Practice Address - Fax:209-966-8251
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIPOSA COUNTY BEHAVIORAL HEALTH & RECOVERY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-26
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABV718AMedicare UPIN