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Organization
RIVERSIDE COUNTY MENTAL HEALTH DEPT.
Active
Organization
RIVERSIDE COUNTY MENTAL HEALTH DEPT.
Active
Other names
PERRIS FAMILY ROOM CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY WICKI (BH MFT/SUPERVISOR)
(951) 443-2200
Entity
Organization
Contact information
Practice address
1688 N PERRIS BLVD, SUITE L6-11, PERRIS, CA 92571
(951) 443-2200
(951) 443-2230
Mailing address
1688 N PERRIS BLVD, SUITE L6-11, PERRIS, CA 92571-4709
(951) 443-2200
(951) 443-2230
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1649384041
MEDICAL
CA
05
—
1649384041
—
CA
Enumeration date
11/07/2016
Last updated
11/07/2016
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