Healthcare Provider Details

I. General information

NPI: 1821917220
Provider Name (Legal Business Name): GO BEHAVIORAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 W BARSTOW AVE APT 107
CLOVIS CA
93612-1512
US

IV. Provider business mailing address

645 W BARSTOW AVE APT 107
CLOVIS CA
93612-1512
US

V. Phone/Fax

Practice location:
  • Phone: 559-278-4843
  • Fax:
Mailing address:
  • Phone: 559-278-4843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: HANNAH LUCAS
Title or Position: REGISTERED BEHAVIOR TECHNICIAN
Credential: BACHELORS
Phone: 559-797-6488