Provider Demographics
NPI:1902929052
Name:COUNTY OF COLUSA
Entity Type:Organization
Organization Name:COUNTY OF COLUSA
Other - Org Name:COLUSA COUNTY MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:530-458-0520
Mailing Address - Street 1:162 E CARSON ST
Mailing Address - Street 2:
Mailing Address - City:COLUSA
Mailing Address - State:CA
Mailing Address - Zip Code:95932-2866
Mailing Address - Country:US
Mailing Address - Phone:530-458-0520
Mailing Address - Fax:530-458-7751
Practice Address - Street 1:162 E CARSON ST
Practice Address - Street 2:
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-2866
Practice Address - Country:US
Practice Address - Phone:530-458-0520
Practice Address - Fax:530-458-7751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicaid