Provider Demographics
NPI:1669674446
Name:COMMUNITY BEHAVIORAL INTERVENTION SERVICES
Entity Type:Organization
Organization Name:COMMUNITY BEHAVIORAL INTERVENTION SERVICES
Other - Org Name:UNIVERSITY OF THE PACIFIC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRIS
Authorized Official - Middle Name:T
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:209-946-2132
Mailing Address - Street 1:3601 PACIFIC AVE
Mailing Address - Street 2:PSYCHOLOGY DEPARTMENT
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95211-0110
Mailing Address - Country:US
Mailing Address - Phone:209-946-2132
Mailing Address - Fax:209-946-2284
Practice Address - Street 1:3601 PACIFIC AVE
Practice Address - Street 2:PSYCHOLOGY DEPARTMENT
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95211-0110
Practice Address - Country:US
Practice Address - Phone:209-946-2132
Practice Address - Fax:209-946-2284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9043OtherMEDICAL