Provider Demographics
NPI:1568642551
Name:SOUTH COUNTY BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:SOUTH COUNTY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MENTAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:530-225-5200
Mailing Address - Street 1:2889 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-3444
Mailing Address - Country:US
Mailing Address - Phone:530-378-6840
Mailing Address - Fax:
Practice Address - Street 1:2889 E CENTER ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007-3444
Practice Address - Country:US
Practice Address - Phone:530-378-6840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SHASTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health