Healthcare Provider Details

I. General information

NPI: 1336373554
Provider Name (Legal Business Name): FRESNO COUNTY BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 05/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 E KINGS CANYON RD
FRESNO CA
93702-3604
US

IV. Provider business mailing address

5108 E CLINTON WAY STE 108
FRESNO CA
93727-2043
US

V. Phone/Fax

Practice location:
  • Phone: 559-453-8905
  • Fax:
Mailing address:
  • Phone: 559-452-3470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GIANG NGUYEN
Title or Position: MENTAL HEALTH DIRECTOR
Credential: RN
Phone: 559-452-3463