Organization
MENDOCINO COUNTY YOUTH PROJECT
Active
Other names
MCYP Behavioral Health Services - Medication Support
Organization subpart
No
Provider details
NPI number
Authorized official
MIMINE AMBROIS LCSW (DIRECTOR OF CLINICAL PROGRAM)
(707) 463-4915
Entity
Organization
Contact information
Practice address
376 E GOBBI ST STE B, UKIAH, CA 95482-5511
(707) 463-4915
Mailing address
776 S STATE ST STE 107, UKIAH, CA 95482-5858
(707) 463-4915
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
94-2882841
—
CA
Enumeration date
05/31/2017
Last updated
06/16/2017
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