Provider Demographics
NPI:1962750505
Name:LIONROCK BEHAVIORAL HEALTH, INC
Entity type:Organization
Organization Name:LIONROCK BEHAVIORAL HEALTH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/SECRETARY/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRABB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-994-4990
Mailing Address - Street 1:911 LAKEVILLE ST
Mailing Address - Street 2:MB 322
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3329
Mailing Address - Country:US
Mailing Address - Phone:760-994-4990
Mailing Address - Fax:866-899-8670
Practice Address - Street 1:621 E CAMPBELL AVE
Practice Address - Street 2:SUITE 17
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2139
Practice Address - Country:US
Practice Address - Phone:760-994-4990
Practice Address - Fax:866-899-8670
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIONROCK BEHAVIORAL HEALTH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-28
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
CA430074AP251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health