Organization
COUNTY OF MENDOCINO
Active
Organization
COUNTY OF MENDOCINO
Active
Other names
Substance Use Disorders Treatment
Organization subpart
No
Provider details
NPI number
Authorized official
JENINE MILLER PSY.D. (DIRECTOR)
(707) 472-2637
Entity
Organization
Contact information
Practice address
790 S FRANKLIN ST, FORT BRAGG, CA 95437-5456
(707) 961-2522
Mailing address
1120 S. DORA STREET, UKIAH, CA 95482-6340
(707) 472-2637
(707) 472-2657
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QP0904X
Federal Public Health Clinic/Center
—
—
261QP0905X
State or Local Public Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2306
DRUG MEDI-CAL
CA
Enumeration date
01/29/2007
Last updated
04/14/2025
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