| County Of Lake | |
|
525 N Main St Lakeport CA 95453-4811 | |
| (707) 263-4880 | |
| Not Available |
| Full Name | County Of Lake |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 525 N Main St, Lakeport, California |
| Authorized Official Name and Position | Elise Jones Ma (DIRECTOR) |
| Authorized Official Contact | 7072749101 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| County Of Lake Po Box 1024 Lucerne CA 95458-1024 Ph: (707) 263-4880 | County Of Lake 525 N Main St Lakeport CA 95453-4811 Ph: (707) 263-4880 |
| NPI Number | 1356181234 |
|---|---|
| Provider Enumeration Date | 05/29/2024 |
| Last Update Date | 08/26/2024 |
| Certification Date | 08/26/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356181234 | NPI | - | NPPES |
| 17E2 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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