1578751731 NPI number — BARBARA JEAN MOSTELLER MENTAL HEALTH WORKER

Table of content: BARBARA JEAN MOSTELLER MENTAL HEALTH WORKER (NPI 1578751731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578751731 NPI number — BARBARA JEAN MOSTELLER MENTAL HEALTH WORKER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSTELLER
Provider First Name:
BARBARA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MENTAL HEALTH WORKER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578751731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
58945 BUSINESS CENTER DR
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
YUCCA VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92284-7307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-228-9657
Provider Business Mailing Address Fax Number:
760-369-6758

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
48585 OCOTILLO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92285-2855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-364-4892
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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