Provider Demographics
NPI:1619441615
Name:COUNTY OF HUMBOLDT
Entity Type:Organization
Organization Name:COUNTY OF HUMBOLDT
Other - Org Name:ADOLESCENT TREATMENT PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MENTAL HEALTH 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:MFT
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:707-268-2990
Mailing Address - Fax:
Practice Address - Street 1:2004 HARRISON AVE RM 3-4
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3212
Practice Address - Country:US
Practice Address - Phone:707-268-2990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health