Organization
COUNTY OF LAKE
Active
Other names
AODS CLEARLAKE
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTY KELLY MFT (DEPARTMENT HEAD)
(707) 263-4338
Entity
Organization
Contact information
Practice address
9345 WINCHESTER ST, LOWER LAKE, CA 95457-5000
(707) 994-6494
(707) 994-7092
Mailing address
991 PARALLEL DR., STE. B, LAKEPORT, CA 95453-5717
(707) 263-8162
(707) 263-9336
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
170002BN
CA
Other
Enumeration date
03/11/2011
Last updated
08/26/2024
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