Healthcare Provider Details

I. General information

NPI: 1619768322
Provider Name (Legal Business Name): CENTRAL VALLEY BEHAVIORAL HEALTH PSYCHOLOGY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 N FILBERT AVE
CLOVIS CA
93619-4297
US

IV. Provider business mailing address

1781 E FIR AVE STE 101
FRESNO CA
93720-3865
US

V. Phone/Fax

Practice location:
  • Phone: 559-326-7775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW TATUM
Title or Position: CEO
Credential:
Phone: 559-593-9801