Provider Demographics
NPI:1619043320
Name:COUNTY OF TUOLUMNE
Entity Type:Organization
Organization Name:COUNTY OF TUOLUMNE
Other - Org Name:TUOLUMNE COUNTY BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HCIS
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:DEMELLO
Authorized Official - Last Name:MARISCAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-533-6261
Mailing Address - Street 1:2 S GREEN STREET
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5163
Mailing Address - Country:US
Mailing Address - Phone:209-533-6245
Mailing Address - Fax:209-588-9563
Practice Address - Street 1:197 MONO WAY
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5163
Practice Address - Country:US
Practice Address - Phone:209-533-5400
Practice Address - Fax:209-588-9563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)