Healthcare Provider Details

I. General information

NPI: 1104681022
Provider Name (Legal Business Name): COURAGE-U
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/20/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 N GATEWAY BLVD
FRESNO CA
93727-1604
US

IV. Provider business mailing address

1960 N GATEWAY BLVD
FRESNO CA
93727-1604
US

V. Phone/Fax

Practice location:
  • Phone: 559-266-5200
  • Fax: 559-266-5201
Mailing address:
  • Phone: 559-266-5200
  • Fax: 559-266-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MOR XIONG POPPER
Title or Position: EXECUTIVE CLINICAL DIRECTOR
Credential: LCSW
Phone: 559-266-5200