Healthcare Provider Details

I. General information

NPI: 1407672918
Provider Name (Legal Business Name): CONNECTED CARE FAMILY THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2024
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2728 GOSHEN AVE
CLOVIS CA
93611-8175
US

IV. Provider business mailing address

2728 GOSHEN AVE
CLOVIS CA
93611-8175
US

V. Phone/Fax

Practice location:
  • Phone: 818-746-6007
  • Fax:
Mailing address:
  • Phone: 818-746-6007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH KURTZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 559-203-2042