NPIMap

Organization Active NPI

Humboldt County Behavioral Health

Doing business as Fortuna Clinic

  • Community/Behavioral Health Agency
  • Fortuna, CA
National Provider Identifier
1669093712
Registry record updated Apr 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
HUMBOLDT COUNTY BEHAVIORAL HEALTH
Doing business as
Fortuna Clinic
Practice address
3306 Renner Dr
Fortuna, CA 95540-3120
Phone
(707) 268-2990
NPI assigned
Apr 29, 2020
Last updated
Apr 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2020

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

Authorized official

Name
Emi Botzler-Rogers, LMFT
Title
Behavioral Health Director
Phone
(707) 268-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

3306 Renner Dr
Fortuna, CA 95540-3120

Mailing address

720 Wood St
Eureka, CA 95501-4413
Phone (707) 268-2990

Other names 1

  • Fortuna Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Humboldt County Mental35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

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

View all 34

Locations

3306 Renner Dr
Fortuna, CA 95540
Phone (707) 725-4477

NPI Registry JSON

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

{
    "created_epoch": "1588118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588118400000",
    "number": "1669093712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 WOOD ST",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955014413",
            "telephone_number": "707-268-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3306 RENNER DR",
            "city": "FORTUNA",
            "state": "CA",
            "postal_code": "955403120",
            "telephone_number": "707-268-2990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMBOLDT COUNTY BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-29",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A",
        "authorized_official_last_name": "BOTZLER-ROGERS",
        "authorized_official_first_name": "EMI",
        "authorized_official_title_or_position": "BEHAVIORAL HEALTH DIRECTOR",
        "authorized_official_telephone_number": "707-268-2990",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fortuna Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fortuna, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.