Provider Demographics
NPI:1932255577
Name:SAN JOAQUIN COUNTY OFFICE OF EDUCATION
Entity Type:Organization
Organization Name:SAN JOAQUIN COUNTY OFFICE OF EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SAN JOAQUIN COUNTY SUPERINTENDENT O
Authorized Official - Prefix:DR
Authorized Official - First Name:MICK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FOUNTS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:209-468-4802
Mailing Address - Street 1:PO BOX 213030
Mailing Address - Street 2:2901 ARCH-AIRPORT ROAD
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95213-9030
Mailing Address - Country:US
Mailing Address - Phone:209-468-4960
Mailing Address - Fax:209-468-4955
Practice Address - Street 1:2707 TRANSWORLD DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-3948
Practice Address - Country:US
Practice Address - Phone:209-468-4960
Practice Address - Fax:209-468-4955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
CASS3910397251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251300000XAgenciesLocal Education Agency (LEA)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS3910397Medicaid