Healthcare Provider Details

I. General information

NPI: 1356865679
Provider Name (Legal Business Name): FRESNO MENTAL PSYCHOLOGICAL HEALTH SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4021 N FRESNO STREET, STE. 101
FRESNO CA
93726
US

IV. Provider business mailing address

4021 N FRESNO ST STE 101
FRESNO CA
93726-4030
US

V. Phone/Fax

Practice location:
  • Phone: 559-307-9505
  • Fax:
Mailing address:
  • Phone: 559-307-9505
  • 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: CHARMAINE RADELLANT
Title or Position: PSYCHOLOGIST
Credential: PSY.D.
Phone: 559-307-9505