Healthcare Provider Details

I. General information

NPI: 1144809161
Provider Name (Legal Business Name): POVERELLO HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 F ST
FRESNO CA
93706-3409
US

IV. Provider business mailing address

412 F ST
FRESNO CA
93706-3409
US

V. Phone/Fax

Practice location:
  • Phone: 559-498-6988
  • Fax:
Mailing address:
  • Phone: 559-498-6988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. XAINYAVONG VANG
Title or Position: DIRECTOR OF MENTAL HEALTH SERVICES
Credential: LPCC 16877
Phone: 559-498-6988