Healthcare Provider Details

I. General information

NPI: 1417334392
Provider Name (Legal Business Name): FRESNO COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2719 N AIR FRESNO DR
FRESNO CA
93727-1547
US

IV. Provider business mailing address

2719 N AIR FRESNO DR
FRESNO CA
93727-1547
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-9193
  • Fax:
Mailing address:
  • Phone: 559-600-9193
  • 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 StateCA

VIII. Authorized Official

Name: SUSAN L HOLT
Title or Position: DIRECTOR
Credential: LMFT
Phone: 559-600-9058