NPIMap

Organization Active NPI

County of Mendocino

  • Community/Behavioral Health Agency
  • Fort Bragg, CA
National Provider Identifier
1194853713
Registry record updated Dec 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
COUNTY OF MENDOCINO
Practice address
790 S Franklin St Ste B
Fort Bragg, CA 95437-5456
Phone
(707) 964-4747
NPI assigned
Mar 2, 2007
Last updated
Dec 2, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
COUNTY OF MENDOCINOAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jenine Miller, PSY.D.
Title
Director
Phone
(707) 472-2355

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Exclusive Provider Organization 302F00000X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

790 S Franklin St Ste B
Fort Bragg, CA 95437-5456

Mailing address

1120 S Dora St
Ukiah, CA 95482
Phone (707) 467-2300

Other identifiers 3

IdentifierTypeStateIssuer
2311MedicaidCA
00023MedicaidCA
BBB33295BOtherCAMH SUBMITTER #

Other names 1

  • Behavioral Health & Recovery Services - Mental Health Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040520001485 CA Part B Supplier - Clinic/Group Practice 8325033301 Receives reassigned benefits from 1 practitioner
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fort Bragg, CA; Willits, CA; Ukiah, CA

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Mendocino Cty HLTH Dept12 organizations share this tax ID, including this one
Part of
Mendocino Cty HLTH Dept

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

120 W Fir St
Fort Bragg, CA 95437
Phone (707) 921-2619

790 S Franklin St
Ste B
Fort Bragg, CA 95437
Phone (707) 961-2669

1120 S Dora St
Ukiah, CA 95482
Phone (707) 472-2600

501 Low Gap Rd
Bsmt
Ukiah, CA 95482
Phone (707) 463-4145

860 N Bush St
Ukiah, CA 95482
Phone (707) 463-4303

472 E Valley St
#B
Willits, CA 95490
Phone (707) 456-3853

Practitioners & affiliated clinicians

Practitioners 57

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 57

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701475200000",
    "number": "1194853713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 S DORA ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "95482",
            "telephone_number": "707-467-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 S FRANKLIN ST STE B",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954375456",
            "telephone_number": "707-964-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF MENDOCINO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF MENDOCINO",
        "enumeration_date": "2007-03-02",
        "last_updated": "2023-12-02",
        "certification_date": "2023-12-02",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "JENINE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "707-472-2355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2311",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00023",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MH SUBMITTER #",
            "identifier": "BBB33295B",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Behavioral Health & Recovery Services - Mental Health",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Bragg, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.