Healthcare Provider Details

I. General information

NPI: 1154591121
Provider Name (Legal Business Name): PROMESA BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 N MARKS AVE # 110
FRESNO CA
93711
US

IV. Provider business mailing address

7120 N MARKS AVE # 110
FRESNO CA
93711-0268
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-5437
  • Fax: 559-439-5411
Mailing address:
  • Phone: 559-439-5437
  • Fax: 559-439-5411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number1044
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number100043AN
License Number StateCA

VIII. Authorized Official

Name: AMANDA IRENE REED
Title or Position: DIRECTOR
Credential: LMFT
Phone: 559-341-2394