Healthcare Provider Details

I. General information

NPI: 1932020435
Provider Name (Legal Business Name): THIRD SPACE FAMILY THERAPY, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3167 N MCARTHUR AVE
FRESNO CA
93727-8909
US

IV. Provider business mailing address

3167 N MCARTHUR AVE
FRESNO CA
93727-8909
US

V. Phone/Fax

Practice location:
  • Phone: 559-906-8810
  • Fax: 559-906-8810
Mailing address:
  • Phone: 559-906-8810
  • Fax: 559-906-8810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DANA CHARLES
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LMFT
Phone: 559-906-8810