Provider Demographics
NPI:1043032378
Name:TRANSITION-MENTAL HEALTH ASSOCIATION
Entity type:Organization
Organization Name:TRANSITION-MENTAL HEALTH ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLSTER-WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-540-6515
Mailing Address - Street 1:784 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5243
Mailing Address - Country:US
Mailing Address - Phone:805-540-6500
Mailing Address - Fax:
Practice Address - Street 1:1998 SANTA BARBARA AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4427
Practice Address - Country:US
Practice Address - Phone:805-540-6515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRANSITION-MENTAL HEALTH ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness