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Organization
STANISLAUS COUNTY
Active
Organization
STANISLAUS COUNTY
Active
Parent organization
COUNTY OF STANISLAUS
Other names
FEE FOR SERVICE - PSYCHOLOGIST
Organization subpart
Yes
Provider details
NPI number
Legal business name
COUNTY OF STANISLAUS
Authorized official
RUBEN IMPERIAL MBA (BEHAVIORAL HEALTH INTERIM DIRECTOR)
(209) 525-6225
Entity
Organization
Contact information
Practice address
800 SCENIC DR, MODESTO, CA 95350-6131
(209) 558-4752
Mailing address
800 SCENIC DR, MODESTO, CA 95350-6131
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5055
—
CA
Enumeration date
05/29/2007
Last updated
10/11/2019
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