Provider Demographics
NPI:1639852387
Name:S&G BEHAVIORAL HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:S&G BEHAVIORAL HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, FNP-C PMHNP-BC
Authorized Official - Phone:307-761-4249
Mailing Address - Street 1:2167 SHAW AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-8935
Mailing Address - Country:US
Mailing Address - Phone:307-761-4249
Mailing Address - Fax:
Practice Address - Street 1:3445 WINTON PL STE 109
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2950
Practice Address - Country:US
Practice Address - Phone:307-761-4249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health