Healthcare Provider Details

I. General information

NPI: 1306559042
Provider Name (Legal Business Name): FAMILY THERAPY SOLUTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648 GETTYSBURG AVE
CLOVIS CA
93611-4541
US

IV. Provider business mailing address

PO BOX 2033
CLOVIS CA
93613-2033
US

V. Phone/Fax

Practice location:
  • Phone: 559-825-1098
  • Fax:
Mailing address:
  • Phone: 559-825-1098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JAYLENE BOOTH
Title or Position: BILLING
Credential:
Phone: 805-441-8398