Organization
MENDOCINO COUNTY
Active
Other names
Behavioral Health & Recovery Services - Mental Health
Organization subpart
No
Provider details
NPI number
Authorized official
JENINE MILLER PSY.D. (BHRS DEPUTY DIRECTOR)
(707) 472-2300
Entity
Organization
Contact information
Practice address
474 E VALLEY ST, WILLITS, CA 95490-3606
(707) 472-2300
(707) 472-2331
Mailing address
1120 S DORA ST, UKIAH, CA 95482-6340
(707) 472-2300
(707) 472-2331
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
302F00000X
Exclusive Provider Organization
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00023
—
CA
05
—
2367
—
CA
01
—
BBB33295B
MH SUBMITTER #
CA
Enumeration date
03/05/2007
Last updated
01/17/2024
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