Provider Demographics
NPI:1720323454
Name:SAN LUIS OBISPO COUNTY BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:SAN LUIS OBISPO COUNTY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA,RAS
Authorized Official - Phone:905-781-4861
Mailing Address - Street 1:227 SOUTH STREET
Mailing Address - Street 2:SUITE T
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401
Mailing Address - Country:US
Mailing Address - Phone:805-781-4750
Mailing Address - Fax:
Practice Address - Street 1:227 SOUTH STREET
Practice Address - Street 2:SUITE T
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401
Practice Address - Country:US
Practice Address - Phone:805-781-4750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization