Provider Demographics
NPI:1720663271
Name:SB CTY DEPT OF BEHAVIORAL WELLNESS
Entity Type:Organization
Organization Name:SB CTY DEPT OF BEHAVIORAL WELLNESS
Other - Org Name:CUYAMA VALLEY HIGH SCHOOL TELEHEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:QCM COORDINATOR / DESIGNEE
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:
Mailing Address - Fax:
Practice Address - Street 1:7670 CUYAMA HWY
Practice Address - Street 2:
Practice Address - City:NEW CUYAMA
Practice Address - State:CA
Practice Address - Zip Code:93254-0401
Practice Address - Country:US
Practice Address - Phone:805-555-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health