Provider Demographics
NPI:1700328929
Name:RIVERSIDE COUNTY MENTAL HEALTH DEPT.
Entity type:Organization
Organization Name:RIVERSIDE COUNTY MENTAL HEALTH DEPT.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BH MFT/SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:WICKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-443-2200
Mailing Address - Street 1:1688 N PERRIS BLVD
Mailing Address - Street 2:SUITE L6-11
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-4709
Mailing Address - Country:US
Mailing Address - Phone:951-443-2200
Mailing Address - Fax:951-443-2230
Practice Address - Street 1:1688 N PERRIS BLVD
Practice Address - Street 2:SUITE L6-11
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571
Practice Address - Country:US
Practice Address - Phone:951-443-2200
Practice Address - Fax:951-443-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1649384041Medicaid
CA1649384041OtherMEDICAL