Provider Demographics
NPI:1841471943
Name:SAN LUI OBISPO CENTER FOR CHANGE
Entity type:Organization
Organization Name:SAN LUI OBISPO CENTER FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASSENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-544-2892
Mailing Address - Street 1:285 SOUTH ST
Mailing Address - Street 2:SUITE M
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5037
Mailing Address - Country:US
Mailing Address - Phone:805-544-2892
Mailing Address - Fax:805-544-2887
Practice Address - Street 1:285 SOUTH ST
Practice Address - Street 2:SUITE M
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-5037
Practice Address - Country:US
Practice Address - Phone:805-544-2892
Practice Address - Fax:805-544-2887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA50361Medicaid