HUMBOLDT COUNTY BEHAVIORAL HEALTH (NPI# 1669093712) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669093712 |
| Entity Type | Organization |
| Organization Name | HUMBOLDT COUNTY BEHAVIORAL HEALTH |
| Other Organization Name | FORTUNA CLINIC |
| Practice Address |
3306 Renner Dr Fortuna CA 95540-3120 |
| Mailing Address |
720 Wood St Eureka CA 95501-4413 |
| Practice Telephone | 7072682990 |
| Mailing Telephone | 7072682990 |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2020-04-29 |
| Authorized Official Name | EMI BOTZLER-ROGERS (BEHAVIORAL HEALTH DIRECTOR) |
| Authorized Official Telephone | 7072682990 |
| Authorized Official Credential | LMFT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| Other Name | Type Code |
|---|---|
| Fortuna Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477174555 | Humboldt County Behavioral Health | Community/Behavioral Health | 1615 Heartwood Drive, Mckinleyville, CA 95519 | 2020-04-30 |
| 1609406404 | Humboldt County Behavioral Health | Community/Behavioral Health | 638 W Clark St., Bldg. E, Eureka, CA 95501 | 2020-01-21 |
| 1083266886 | Humboldt County Behavioral Health | Community/Behavioral Health | 2944 D St, Eureka, CA 95501-4349 | 2019-07-11 |
| 1811267917 | Humboldt County Behavioral Health | Community/Behavioral Health | 550 I St, Eureka, CA 95501-1117 | 2012-01-05 |
| 1194025890 | Humboldt County Behavioral Health | Community/Behavioral Health | 77 Walnut Way, Willow Creek, CA 95573 | 2010-10-27 |
| 1063657666 | Humboldt County Behavioral Health | Community/Behavioral Health | 231 2nd St, Eureka, CA 95501-0319 | 2008-12-10 |
| 1518085216 | Humboldt County Behavioral Health | Community/Behavioral Health | 808 E St, Eureka, CA 95501-1856 | 2007-03-27 |
| 1144348897 | Humboldt County Behavioral Health | Community/Behavioral Health | 727 Cedar St, Garberville, CA 95542-3201 | 2007-03-27 |
| 1598883274 | Humboldt County Behavioral Health | Community/Behavioral Health | 638 W Clark St, Eureka, CA 95501 | 2007-03-27 |
| 1164576922 | Humboldt County Behavioral Health | Community/Behavioral Health | 2440 6th St, Eureka, CA 95501-0788 | 2007-01-22 |
| Street Address |
3306 RENNER DR |
| City | FORTUNA |
| State | CA |
| Zip Code | 95540-3120 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134179377 | Humboldt Medical Group | Family Medicine | 3306 Renner Dr, Fortuna, CA 95540-3120 | 2006-05-10 |
| 1316447808 | Christy Rae Bascochea | Registered Nurse | 3306 Renner Dr, Fortuna, CA 95540-3120 | 2018-02-20 |
| 1740708874 | Nicole T. Walters | Registered Nurse | 3306 Renner Dr, Fortuna, CA 95540-3120 | 2017-09-08 |
| 1215487947 | Pamela Jean Russ | Registered Nurse | 3306 Renner Dr, Fortuna, CA 95540-3120 | 2016-10-05 |
| 1619360963 | Judy Gallagher | Registered Nurse | 3306 Renner Dr, Fortuna, CA 95540-3120 | 2015-03-11 |
| 1508202821 | Margarette Jeannette Shegog | Family Medicine | 3306 Renner Dr, Fortuna, CA 95540 | 2013-05-14 |
| 1063746287 | Angela Noelle Murray | Physician Assistant | 3306 Renner Dr, Fortuna, CA 95540-3120 | 2009-09-21 |
| 1023183969 | Maureen B Frank | Nurse Practitioner | 3306 Renner Dr, Fortuna, CA 95540-3120 | 2006-11-22 |
| 1790735223 | Rodney Blaine Grover | Family Medicine | 3306 Renner Dr, Fortuna, CA 95540-3120 | 2006-05-12 |
| 1891745428 | Robert G Smith | Registered Nurse | 3306 Renner Dr, Fortuna, CA 95540-3120 | 2006-05-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234787 | Remi Vista, Inc. | Community/Behavioral Health | 3000 Newburg, Fortuna, CA 95540 | 2020-01-21 |
| 1144867474 | Paula-marie Schneider | Registered Nurse | 3750 Rohnerville Rd., Fortuna, CA 95540 | 2019-12-05 |
| 1609265537 | Nancy Stinson Lollich | Physical Therapy Assistant | 2321 Newburg Road, Fortuna Rehabilitation and Wellness, Fortuna, CA 95540 | 2015-01-15 |
| 1730438151 | Heber House Inc. Dba Dermatology Center | Dermatology | 2404 Newburg Rd., Fortuna, CA 95540 | 2012-08-30 |
| 1104173418 | Michelle Leigh Hoopes | Physician Assistant | 3304 Renner Dr Suite B, Fortuna, CA 95540 | 2012-08-07 |
| 1205181526 | Constance Mitchell | Registered Nurse | Redwood Pediatrics, 3305 Renner Dr, Fortuna, CA 95540 | 2012-07-24 |
| 1730457177 | Joy Nadine Frasier | Counselor | 220 Wilson Ln., Fortuna, CA 95540 | 2011-12-13 |
| 1063791713 | Gardenside Eldercare, LLC | Residential Treatment Facility, Physical Disabilities | 529 9th Street, Fortuna, CA 95540 | 2011-08-12 |
| 1093025173 | Sheri A Jewett | Massage Therapist | 2655 Virginia Court, Fortuna, CA 95540 | 2010-10-07 |
| 1134371339 | Mariana Van Der Merwe | Pharmacist | 725 South Boulevard, Rite Aid Pharmacy, Fortuna, CA 95540 | 2008-10-21 |
| Find all providers in zip 95540 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234787 | Remi Vista, Inc. | Community/Behavioral Health | 3000 Newburg, Fortuna, CA 95540 | 2020-01-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740881861 | Griselda Tuchan Pineda Marriage and Family Therapist Inc | Community/Behavioral Health | 2820 S Vermont Ave Ste 16, Los Angeles, CA 90007-2291 | 2020-11-04 |
| 1013518687 | Turning Point of Central California, Inc. | Community/Behavioral Health | 3636 N 1st St Ste 112, Fresno, CA 93726-6818 | 2020-11-02 |
| 1588264113 | Licensed Clinical Social Worker Community Alliance PC | Community/Behavioral Health | 301 S 23rd St, Richmond, CA 94804-2807 | 2020-11-01 |
| 1134729718 | Cynthia Felicia Delaney | Community/Behavioral Health | 4887 Bella Pacific Row Unit 240, San Diego, CA 92109-8515 | 2020-10-31 |
| 1114527637 | Clarke-lauren Stevenson Richard | Community/Behavioral Health | 1277 E Loma Linda Ave, Fresno, CA 93720-2668 | 2020-10-26 |
| 1891395232 | Jacqulyn Danielle Rios | Community/Behavioral Health | 4604 W Douglas Ave Apt 103, Visalia, CA 93291-4195 | 2020-10-26 |
| 1346849213 | Greystone Behavioral Health Nursing Inc | Community/Behavioral Health | 231 E Alessandro Blvd Ste A438, Riverside, CA 92508-5084 | 2020-10-22 |
| 1376142216 | Melissa Reyes Aguilar | Community/Behavioral Health | 2248 S Cochran Ave, Los Angeles, CA 90016-1218 | 2020-10-21 |
| 1578162616 | Bayfront Healthcare Services | Community/Behavioral Health | 2703 N Studebaker Rd, Long Beach, CA 90815-1628 | 2020-10-20 |
| 1326647686 | Sierra Child & Family Services | Community/Behavioral Health | 564 Mountain Ranch Rd Ste 5, San Andreas, CA 95249-9782 | 2020-10-19 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on HUMBOLDT COUNTY BEHAVIORAL HEALTH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.