Healthcare Provider Details

I. General information

NPI: 1699827576
Provider Name (Legal Business Name): SUPPORTED EDUCATION EMPLOYMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4447 E KINGS CANYON ROAD, UNIT E
FRESNO CA
93703
US

IV. Provider business mailing address

4447 E KINGS CANYON ROAD, UNIT E
FRESNO CA
93702
US

V. Phone/Fax

Practice location:
  • Phone: 559-453-8637
  • Fax:
Mailing address:
  • Phone: 559-452-3463
  • Fax: 559-452-3470

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: DAWAN UTECHT
Title or Position: DIRECTOR, DEPARTMENT OF BEHAVIORAL
Credential:
Phone: 559-600-9193