Provider Demographics
NPI:1508416322
Name:HUMBOLDT COUNTY BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:HUMBOLDT COUNTY BEHAVIORAL HEALTH
Other - Org Name:COMPREHENSIVE COMMUNITY TREATMENT (CCT)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTZLER-ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:707-268-2990
Mailing Address - Street 1:720 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-4413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2933 H ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4407
Practice Address - Country:US
Practice Address - Phone:707-268-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-13
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00001205Medicaid