Provider Demographics
NPI:1598500449
Name:COUNTY OF LAKE
Entity type:Organization
Organization Name:COUNTY OF LAKE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF DEPUTY PROBATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:NOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-262-4292
Mailing Address - Street 1:201 S SMITH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-4921
Mailing Address - Country:US
Mailing Address - Phone:707-262-4285
Mailing Address - Fax:707-262-4292
Practice Address - Street 1:9055 HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:LOWER LAKE
Practice Address - State:CA
Practice Address - Zip Code:95457
Practice Address - Country:US
Practice Address - Phone:707-262-4285
Practice Address - Fax:707-262-4292
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF LAKE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-01
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No305S00000XManaged Care OrganizationsPoint of Service