Provider Demographics
NPI:1154726495
Name:PORTIA BELL HUME BEHAVIORAL HEALTH AND TRAINING CENTER
Entity type:Organization
Organization Name:PORTIA BELL HUME BEHAVIORAL HEALTH AND TRAINING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIKAND
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:925-825-1793
Mailing Address - Street 1:1333 WILLOW PASS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-7930
Mailing Address - Country:US
Mailing Address - Phone:925-825-1793
Mailing Address - Fax:925-825-7094
Practice Address - Street 1:4750 1ST ST
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7334
Practice Address - Country:US
Practice Address - Phone:510-567-8245
Practice Address - Fax:510-639-1346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-29
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14000462261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8187Medicaid
CAZZZ21557ZMedicare PIN