Provider Demographics
NPI:1669654166
Name:SB CTY DEPT OF BEHAVIORAL WELLNESS
Entity type:Organization
Organization Name:SB CTY DEPT OF BEHAVIORAL WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:QCM DESIGNEE/COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASIANO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:805-325-5905
Mailing Address - Street 1:5385 HOLLISTER AVE BLDG 14
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2389
Mailing Address - Country:US
Mailing Address - Phone:805-934-6344
Mailing Address - Fax:
Practice Address - Street 1:212 CARMEN LN
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-7769
Practice Address - Country:US
Practice Address - Phone:805-739-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SB CTY DEPT OF BEHAVIORAL WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-27
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X, 261QM0855X
CA261QM0855X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health