Provider Demographics
NPI:1710193537
Name:SAN JOAQUIN COUNTY BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:SAN JOAQUIN COUNTY BEHAVIORAL HEALTH SERVICES
Other - Org Name:SJC-MHS LA FAMILIA SERVICIOS PSICO SOCIALES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR-BEHAVIORA HEALTH SERV
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:209-468-2082
Mailing Address - Street 1:1212 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1552
Mailing Address - Country:US
Mailing Address - Phone:209-468-8778
Mailing Address - Fax:209-468-2399
Practice Address - Street 1:1149 N EL DORADO ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1305
Practice Address - Country:US
Practice Address - Phone:209-468-8778
Practice Address - Fax:209-468-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9081Medicaid
CAZZZ89455ZMedicare ID - Type Unspecified