Healthcare Provider Details

I. General information

NPI: 1033597620
Provider Name (Legal Business Name): DIALECTICAL BEHAVIOR THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S CEDAR AVE
FRESNO CA
93702-2908
US

IV. Provider business mailing address

515 S CEDAR AVE
FRESNO CA
93702-2908
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-4099
  • Fax:
Mailing address:
  • Phone: 559-600-4099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. DAWAN UTECHT
Title or Position: DIRECTOR
Credential:
Phone: 559-600-9193