Healthcare Provider Details

I. General information

NPI: 1871934067
Provider Name (Legal Business Name): MR. MATTHEW TALKINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 12/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2772 S MARTIN L KING JR BLVD
FRESNO CA
93706
US

IV. Provider business mailing address

2772 S MARTIN L KING JR BLVD
FRESNO CA
93706-5345
US

V. Phone/Fax

Practice location:
  • Phone: 559-265-4800
  • Fax:
Mailing address:
  • Phone: 559-265-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: