Provider Demographics
NPI:1598074304
Name:BUTTE COUNTY DEPARTMENT OF BEHAVIORAL HEATH
Entity Type:Organization
Organization Name:BUTTE COUNTY DEPARTMENT OF BEHAVIORAL HEATH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERN
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOMES
Authorized Official - Suffix:JR
Authorized Official - Credentials:BSW
Authorized Official - Phone:530-872-6389
Mailing Address - Street 1:225 W LASSEN AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-0115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5910 CLARK RD
Practice Address - Street 2:SUITE W
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4856
Practice Address - Country:US
Practice Address - Phone:530-872-6328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
70365OtherSOLE PROPRIETOR