Provider Demographics
NPI:1881048270
Name:SAN JOAQUIN COUNTY BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:SAN JOAQUIN COUNTY BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MH CLINICIAN III
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:209-953-8843
Mailing Address - Street 1:4422 N PERSHING AVE STE D2
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6967
Mailing Address - Country:US
Mailing Address - Phone:209-953-8843
Mailing Address - Fax:209-953-8478
Practice Address - Street 1:4422 N PERSHING AVE STE D2
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6967
Practice Address - Country:US
Practice Address - Phone:209-953-8843
Practice Address - Fax:209-953-8478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health