Healthcare Provider Details

I. General information

NPI: 1417240383
Provider Name (Legal Business Name): VIDAL MICHAEL BEJARANO ASW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 E AMERICAN AVE
FRESNO CA
93725-9247
US

IV. Provider business mailing address

PO BOX 4376
FRESNO CA
93744-4376
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-4881
  • Fax: 559-495-3650
Mailing address:
  • Phone: 559-245-1159
  • Fax: 559-495-3650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number111806
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: