Healthcare Provider Details

I. General information

NPI: 1235314246
Provider Name (Legal Business Name): HOUSE PSYCHIATRIC CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 E SHAW AVE SUITE 410
FRESNO CA
93710-0000
US

IV. Provider business mailing address

1322 E SHAW AVE SUITE 410
FRESNO CA
93710-0000
US

V. Phone/Fax

Practice location:
  • Phone: 559-226-1316
  • Fax: 559-226-1315
Mailing address:
  • Phone: 559-226-1316
  • Fax: 559-226-1315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number2OA7888
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2OA7888
License Number StateCA

VIII. Authorized Official

Name: DR. MATTHEW BENIJAH JUDSON HOUSE
Title or Position: PRESIDENT/CEO
Credential: D.O.
Phone: 559-226-1316