Provider Demographics
NPI:1699821041
Name:SANTA BARBARA COUNTY DEPARTMENT OF BEHAVIORAL WELLNESS
Entity Type:Organization
Organization Name:SANTA BARBARA COUNTY DEPARTMENT OF BEHAVIORAL WELLNESS
Other - Org Name:LOMPOC CHILDREN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:QCM COORDINATOR / DESIGNEE
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASIANO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:805-325-5905
Mailing Address - Street 1:5385 HOLLISTER AVE BLDG 14
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2389
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 EAST OCEAN AVENUE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436
Practice Address - Country:US
Practice Address - Phone:805-737-6600
Practice Address - Fax:805-737-6601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SB COUNTY DEPARTMENT OF BEHAVIORAL WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-26
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0855X
CA261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health