Provider Demographics
NPI:1184893554
Name:SAN LUIS OBISPO COUNTY PROBATION DEPARTMENT
Entity type:Organization
Organization Name:SAN LUIS OBISPO COUNTY PROBATION DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPO II
Authorized Official - Prefix:MR
Authorized Official - First Name:WATSON
Authorized Official - Middle Name:P
Authorized Official - Last Name:GOOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-781-5369
Mailing Address - Street 1:1276 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93408-0001
Mailing Address - Country:US
Mailing Address - Phone:805-781-5369
Mailing Address - Fax:805-781-1231
Practice Address - Street 1:1276 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93408-0001
Practice Address - Country:US
Practice Address - Phone:805-781-5369
Practice Address - Fax:805-781-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251B00000X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management