Provider Demographics
NPI:1699219881
Name:FOOTHILL COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:FOOTHILL COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH CLINICIAN II
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:HICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:408-755-3905
Mailing Address - Street 1:1650 S WHITE RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-4758
Mailing Address - Country:US
Mailing Address - Phone:408-928-5250
Mailing Address - Fax:
Practice Address - Street 1:1650 S WHITE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-4758
Practice Address - Country:US
Practice Address - Phone:408-928-5250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46836251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management