Provider Demographics
NPI:1508913815
Name:SAN LUIS OBISPO COUNTY BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:SAN LUIS OBISPO COUNTY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST IV
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:HUDDLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:805-474-2028
Mailing Address - Street 1:1086 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2505
Mailing Address - Country:US
Mailing Address - Phone:805-474-2028
Mailing Address - Fax:805-474-2025
Practice Address - Street 1:1086 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-2505
Practice Address - Country:US
Practice Address - Phone:805-474-2028
Practice Address - Fax:805-474-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40675261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health