Healthcare Provider Details

I. General information

NPI: 1659933281
Provider Name (Legal Business Name): CHAD BRANDON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2261 VILLA AVE
CLOVIS CA
93612-4377
US

IV. Provider business mailing address

2261 VILLA AVE
CLOVIS CA
93612-4377
US

V. Phone/Fax

Practice location:
  • Phone: 559-575-8172
  • Fax: 559-575-8172
Mailing address:
  • Phone:
  • Fax: 559-575-8172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number154220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: