Provider Demographics
NPI:1942427281
Name:COUNTY OF BUTTE
Entity Type:Organization
Organization Name:COUNTY OF BUTTE
Other - Org Name:FEE FOR SERVICE PSYCHOLOGIST
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-879-3824
Mailing Address - Street 1:3217 COHASSET RD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-5404
Mailing Address - Country:US
Mailing Address - Phone:530-891-2980
Mailing Address - Fax:
Practice Address - Street 1:3217 COHASSET RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-5404
Practice Address - Country:US
Practice Address - Phone:530-891-2980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ42951ZMedicare ID - Type Unspecified