Healthcare Provider Details

I. General information

NPI: 1912347741
Provider Name (Legal Business Name): CLOVIS HYBRID AUTISM PROGRAM (CHAPS)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 N SUNNYSIDE AVE
CLOVIS CA
93611-8171
US

IV. Provider business mailing address

965 N SUNNYSIDE AVE
CLOVIS CA
93611-8171
US

V. Phone/Fax

Practice location:
  • Phone: 559-327-8400
  • Fax: 559-327-8179
Mailing address:
  • Phone: 559-327-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number#PSY12625
License Number StateCA

VIII. Authorized Official

Name: DR. SHERRI GIBSON
Title or Position: CLINICAL DIRECTOR
Credential: PH.D
Phone: 559-327-9434