Provider Demographics
NPI:1700923968
Name:DEPARTMENT OF BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:DEPARTMENT OF BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST II
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GRANGER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:909-421-9384
Mailing Address - Street 1:2164 HACKAMORE PL
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4616
Mailing Address - Country:US
Mailing Address - Phone:951-686-4909
Mailing Address - Fax:
Practice Address - Street 1:2164 HACKAMORE PL
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4616
Practice Address - Country:US
Practice Address - Phone:951-686-4909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMMFC 37879251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management