County of Siskiyou
Organization Active NPI Community/Behavioral Health Agency · Mount Shasta, CA
NPI 1427219237 · NPPES record last updated Sep 23, 2024
Key facts
- NPI
- 1427219237
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- COUNTY OF SISKIYOU
- Practice address
- 1107 Ream Ave
Mount Shasta, CA 96067-9768 - Phone
- (530) 918-7200
- Fax
- (530) 918-7216
- NPI assigned
- Jun 24, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- COUNTY OF SISKIYOU BEHAVIORAL HEALTH
Authorized official
- Name
- Rose Marie Bullock
- Title
- Administrative Services Manager
- Phone
- (530) 841-4732
Other NPIs on the same Medicare enrollment 1
Practitioners 24
-
Elvia Amezcua, LCSW
-
Jeremy Goldsmith, LCSW
-
Rinnah Macvittie, FNP-BC; AGNP-C
-
Candace A Ross, MSW, LCSW, MAC, CCTP
-
John Lester Schaeffer, D.O.
-
Carrie Whiting, PA-C
-
David Lee Johnson, M.D.
-
Kellie Nicole Malewski, LMSW, CAADC
-
Erica Picon, LCSW
-
Parker Ross Keim, APCC
-
Laurie Jean Laquey, MFTI
-
Thaen Chiam Saelee, PSY.D
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20121207000287 | CA | Part B Supplier - Clinic/Group Practice | 8224280706 |
Receives reassigned benefits from 12 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Mount Shasta, CA; Yreka, CA |
National Provider Directory
- Part of
- Siskiyou County Behav H
Locations
1107 Ream Ave
Mount Shasta, CA 96067
Phone (530) 918-7200
427 Alder St
Mount Shasta, CA 96067
Phone (530) 841-4734
2060 Campus Dr
Yreka, CA 96097
Phone (530) 841-4100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | CA | Yes |
Addresses
Primary practice location
1107 Ream Ave
Mount Shasta, CA 96067-9768
Mailing address
1107 Ream Ave
Mt. Shasta, CA 96067
Phone (530) 918-7200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01114108 | Medicaid | CA |
Other names
- County of Siskiyou Behavioral Health Services
Other providers in Mount Shasta, CA
- Joseph Champagne
- Alan Cohn
- Jane S Cohn
- Chester A Collins
- Sally J Cooper
- Judith Kay Crabtree
- Hannah Craig
- Hannah Crisci
- Loren Cronk
- Linda Cruz
All providers in Mount Shasta, CA · Community/Behavioral Health Agency in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.