Provider Demographics
NPI:1013049444
Name:STANISLAUS COUNTY BEHAVIORAL HEALTH & RECOVERY SERVICES
Entity Type:Organization
Organization Name:STANISLAUS COUNTY BEHAVIORAL HEALTH & RECOVERY SERVICES
Other - Org Name:NO OTHER NAME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MENTAL HEALTH CLINICIAN I
Authorized Official - Prefix:MS
Authorized Official - First Name:HERMILLE
Authorized Official - Middle Name:NMN
Authorized Official - Last Name:CATZALCO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:209-558-8884
Mailing Address - Street 1:107 GREENWICH LN.
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351
Mailing Address - Country:US
Mailing Address - Phone:209-558-8884
Mailing Address - Fax:209-558-8888
Practice Address - Street 1:1100 KANSAS AVE STE B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-1596
Practice Address - Country:US
Practice Address - Phone:209-558-8884
Practice Address - Fax:209-558-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44780101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty