Provider Demographics
NPI:1174743694
Name:DIABLO BEHAVIORAL HEALTHCARE
Entity type:Organization
Organization Name:DIABLO BEHAVIORAL HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-648-4800
Mailing Address - Street 1:PO BOX 1613
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-6613
Mailing Address - Country:US
Mailing Address - Phone:925-648-4800
Mailing Address - Fax:925-648-2530
Practice Address - Street 1:4185 BLACKHAWK PLAZA CIR
Practice Address - Street 2:SUITE 210
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4694
Practice Address - Country:US
Practice Address - Phone:925-648-2650
Practice Address - Fax:925-648-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 99421041C0700X
CAC290742084P0800X
CAC328212084P0804X, 2084P0800X
CAPSY 14928103TC0700X
CAMFC 41716106H00000X
CASP 10617235Z00000X
CASP 2994235Z00000X
CALEP 2801103TS0200X
CAA1040002084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA40428203OtherEDD
CA=========OtherEIN
CA40428203OtherEDD