Provider Demographics
NPI: | 1558562348 |
---|---|
Name: | COUNTY OF KERN |
Entity Type: | Organization |
Organization Name: | COUNTY OF KERN |
Other - Org Name: | KCMH FFS PSYCHIATRIST |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | WILLIAM |
Authorized Official - Middle Name: | P |
Authorized Official - Last Name: | WALKER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LMFT |
Authorized Official - Phone: | 661-868-6600 |
Mailing Address - Street 1: | PO BOX 1000 |
Mailing Address - Street 2: | |
Mailing Address - City: | BAKERSFIELD |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 93302-1000 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 661-868-6600 |
Mailing Address - Fax: | 661-868-6666 |
Practice Address - Street 1: | 3300 TRUXTUN AVE |
Practice Address - Street 2: | SUITE 290 |
Practice Address - City: | BAKERSFIELD |
Practice Address - State: | CA |
Practice Address - Zip Code: | 93301-3137 |
Practice Address - Country: | US |
Practice Address - Phone: | 661-868-6600 |
Practice Address - Fax: | 661-868-6666 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-05-30 |
Last Update Date: | 2014-09-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 163W00000X | Nursing Service Providers | Registered Nurse | Group - Multi-Specialty | |
No | 163WP0807X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health, Child & Adolescent | Group - Multi-Specialty |
No | 163WP0808X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 1591 | Medicaid |