Provider Demographics
NPI:1285941807
Name:MARIN OUTPATIENT AND RECOVERY SERVICES
Entity type:Organization
Organization Name:MARIN OUTPATIENT AND RECOVERY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:ERVIN
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:415-485-6736
Mailing Address - Street 1:710 C ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3853
Mailing Address - Country:US
Mailing Address - Phone:415-485-6736
Mailing Address - Fax:415-236-1830
Practice Address - Street 1:710 C ST
Practice Address - Street 2:SUITE 8
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3853
Practice Address - Country:US
Practice Address - Phone:415-485-6736
Practice Address - Fax:415-236-1830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210033AN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health