Provider Demographics
NPI:1902211790
Name:COUNTY OF RIVERSIDE DEPARTMENT OF MENTAL HEALTH
Entity Type:Organization
Organization Name:COUNTY OF RIVERSIDE DEPARTMENT OF MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST II
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:CLARA NATHALIE
Authorized Official - Last Name:DARGA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-943-1130
Mailing Address - Street 1:1688 N PERRIS BLVD STE L1
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-4701
Mailing Address - Country:US
Mailing Address - Phone:951-943-1130
Mailing Address - Fax:951-657-7146
Practice Address - Street 1:1688 N PERRIS BLVD STE L1
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-4701
Practice Address - Country:US
Practice Address - Phone:951-943-1130
Practice Address - Fax:951-657-7146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT52196106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty