Provider Demographics
NPI:1528277399
Name:LAKE COUNTY MENTAL HEALTH
Entity type:Organization
Organization Name:LAKE COUNTY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHILDRENS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:707-994-7090
Mailing Address - Street 1:20785 NAPA AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:95461-9706
Mailing Address - Country:US
Mailing Address - Phone:707-987-0199
Mailing Address - Fax:
Practice Address - Street 1:20785 NAPA AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CA
Practice Address - Zip Code:95461-9706
Practice Address - Country:US
Practice Address - Phone:707-987-0199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization