Organization
EMOTIONAL AND BEHAVIORAL HELATH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN TIM ROURKE PHD (OWNER)
(209) 785-7766
Entity
Organization
Contact information
Practice address
1165 RANCH RD, COPPEROPOLIS, CA 95228
(209) 785-7766
Mailing address
PO BOX 189, COPPEROPOLIS, CA 95228-0189
(209) 785-7766
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
12670
CA
Other
Enumeration date
01/29/2010
Last updated
01/29/2010
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