Healthcare Provider Details

I. General information

NPI: 1629137575
Provider Name (Legal Business Name): DEPARTMENT OF BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 E KINGS CANYON RD
FRESNO CA
93702-3604
US

IV. Provider business mailing address

4441 E KINGS CANYON RD
FRESNO CA
93702-3604
US

V. Phone/Fax

Practice location:
  • Phone: 559-453-4099
  • Fax:
Mailing address:
  • Phone: 559-453-4099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS # 21112
License Number StateCA

VIII. Authorized Official

Name: DAWAN UTECHT
Title or Position: MENTAL HEALTH DIRECTOR
Credential:
Phone: 559-600-9193